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The Agenda Physical and Emotional Impact 3/16/2021 Like a Footprint in Wet Cement: Understanding and Applying ACE Research Victor I. Vieth Chief Program Officer, Education & Research Zero Abuse Project [email protected] The agenda • ACE: The most important research in the history of medical science • Ten ideas for addressing ACEs: – Children exposed to violence: school, medical, & mental health collaboration – Physical abuse: o No hit zones o Faith collaborations – Coordinate medical, mental health & spiritual care – ACE screening & education of patients – Addressing ACES by treating juveniles w/ sexual behavior problems – Trauma of boys and men: a simple urology reform – Trauma informed care begins in college Physical and emotional impact 1 3/16/2021 The beginning of ACE: Weight Loss Program • While operating a major weight loss program, medical professionals noticed the program “had a high dropout rate limited almost exclusively to patients successfully losing weight.” (Felitti 2010) (emphasis added) • “…led us to recognize that weight loss is often sexually or physically threatening and that certain of the more intractable public health problems such as obesity were also unconscious, or occasionally conscious, compensatory behaviors that were put in place as solutions to problems dating back to the earliest years, but hidden by time, shame, by secrecy…” (Felitti, 2010) Ten Adverse Childhood Experiences • Emotional abuse (humiliation, threats) (11%) • Physical abuse (hit hard enough to receive injuries) (28%) • Contact sexual abuse (28% women, 16% men) • Mother treated violently (13%) • Household member alcoholic or drug user (27%) • Household member imprisoned (6%) • Household member chronically depressed, suicidal, mentally ill, psychiatric hospitalization (17%) • Not raised by both biological parents (23%) • Neglect—physical (10%) • Neglect—emotional (15%) 1 or more ACE increases risk of: • Cancer • Depression • Heart disease • Anxiety disorders • STDs • Hallucinations • Liver disease • Sleep disturbances • Smoking • Memory disturbances • Alcohol abuse • Anger problems • Obesity • Domestic violence risk • Drug dependence • Job problems • IV Drug Use • Relationship problems • Early intercourse, pregnancy 2 3/16/2021 Ron: Impact of Child Abuse The ACE researchers’ epiphany “In the context of everyday medical practice, we came to recognize that the earliest years of infancy and childhood are not lost but, like a child’s footprints in wet cement are often lifelong.” --Felitti 2010 What happens if doctors simply ask? “When medical professionals asked 440,000 adults undergoing comprehensive medical evaluation about ACEs, there was a 35% reduction in hospital visits in the subsequent year (as opposed to the year before), an 11% reduction in emergency room visits, and 3% reduction in hospitalizations.” (Felitti 2010) 3 3/16/2021 Why would simply asking help? • “…the impression of the clinicians evaluating these patients is that the reduction represents the benefit of having, through a comprehensive medical history, the worst secrets of one’s life understood by another, and still being accepted as a human being.” – Felitti (2010) Polyvictimization research • Exposure to multiple forms of victimization was common. • Almost 66% of the sample was exposed to more than one type of victimization, 30% experienced fıve or more types, and 10% experienced 11 or more different forms of victimization in their lifetimes. • Poly-victims comprise a substantial portion of the children who would be identifıed by screening for an individual victimization type, such as sexual assault or witnessing parental violence. • Poly-victimization is more highly related to trauma symptoms than experiencing repeated victimizations of a single type and explains a large part of the associations between individual forms of victimization and symptom levels. – (Turner, Finkelhor, et al, 2010) Ten ideas for addressing ACEs 4 3/16/2021 1. Children’s Exposure to Violence: Addressing ACEs through school, medical and mental health collaboration © 2012 NCPTC Effects of Exposure to IPV (Summers, 2006) Infants Preschool Age School Age Adolescents •Fussy •Aggression •Aggression •Dating violence •Decreased •Behavior problems •Conduct •Delinquency responsiveness •Regressive behavior problems •Running away •Trouble sleeping •Yelling, irritability •Disobedience •Truancy •Trouble eating •Trouble sleeping •Regressive •Early sexual activity Behavioral behavior •Trouble interacting •Few and low •Dating violence with peers quality peer (victim or perpetrator) •Stranger anxiety relations •Increased risk for teen pregnancy Social © 2012 NCPTC Effects of Exposure to IPV (Summers, 2006) Infants Preschool Age School Age Adolescents •Attachment •Fear/anxiety, •Somatic complaints •Substance abuse needs not met sadness, worry •Fear & anxiety, •Depression •PTSD depression, low self‐ •Suicidal ideation esteem, shame •Negative affect •PTSD •PTSD •Feeling unsafe •Feeling rage, shame •Limited emotional Emotional/ Psychological •Separation anxiety response •Unresponsiveness •Inability to •Self‐blame •Self‐blame •Short attention span understand •Distracted, •Pro‐violent attitude inattentive •Defensive Cognitive •Pro‐violent attitude © 2012 NCPTC 5 3/16/2021 Understand effects of DV on children through drawings An eight‐year‐old was asked to draw a picture of his father. He wrote in Spanish: “This is how I see my father because he often gets angry and drunk and his eyes turn red.” © CONNECT – Family Violence Prevention Fund The case of Kelly • Greets new teacher with a punch • Is the classroom bully • Socially isolated • Expelled from three schools on the verge of a fourth expulsion • Doctors, psychologists, teachers not collaborating • ACE score of seven • The difference of one ACE-informed teacher 2. Addressing the ACE of physical abuse: No Hit Zones 6 3/16/2021 Physical abuse Adverse Childhood Experience research found that 28% of 17,000 adults were beaten to the point of receiving injury – Felitti & Anda (2012) Corporal punishment to physical abuse • A majority of substantiated physical abuse cases in U.S. and Canada involved acts of physical discipline – Gershoff (2008) • Parents who use corporal punishment are 3 times as likely to physically abuse a child and 9 times as likely if they use an object – Zolotor (2011) • 5% of parents use corporal punishment on infants and up to 70% use CP on children on 2-3 year olds – Zolotor (2011) Finkelhor (2019) 7 3/16/2021 The least effective discipline Gershoff (2016) • 75 studies over 50 years • More than 150,000 children • Traditional “spanking” linked to elevated risks of defying parents, acting aggressively, cognitive difficulties, mental health problems The impact on developing brains 8 3/16/2021 Revised AAP statement (2018) One concrete prevention idea 9 3/16/2021 3. Addressing the ACE of physical abuse: Engaging conservative Protestants Conservative Protestants and CP (1986-2014) • “(C)onservative Protestants maintained a high degree of support (for corporal punishment) regardless of their educational attainment, even while others who did attend college withdrew their support the most.” 10 3/16/2021 Commentary on Proverbs 13:24 “The rod refers to a branch or switch. It is a small object that stings, but does not inflict serious bodily harm. The use of the rod for spanking is clearly taught in Scripture in preference to spanking with a hand.” Commentary of Proverbs 13:24 “The Hebrew word translated rod is shevet…In this verse rod occurs with another Hebrew word musar…Together the two words may refer to physical punishment; they may refer to verbal correction; and they may have to do with sharing knowledge with a young student.” The alternative view used in Perrin research • Webb is a seminary professor • Used to teach corporal punishment • Changed his views, at least in part, after dialoguing with survivors of child physical abuse 11 3/16/2021 William J. Webb • If Bible literally followed, children would be: – Struck by an instrument – On the back – With no limitations as to amount of blows – No concern for injuries • Most conservative Protestants reject corporal punishment of this nature The rejection of adult CP • More Biblical references to adult CP: – “A fool’s lips bring strife, and a fool’s mouth invites a flogging (Pr. 18:6) – “…A rod is for the back of one who lack’s common sense” (Pr. 10:13) – “A whip is for a horse, a bridle for a donkey, and a rod for the back of fools.” (Pr. 26:3; 10:13) – “Blows that wound cleanse away evil; beatings make clean the innermost parts” (Pr. 20:30) Why not physically discipline adults? • Most Catholic and Protestant theologians no longer apply these verses literally because they simply reflected governmental punishments of the era in which they were written • Would not the same argument apply to child CP? 12 3/16/2021 Perrin & Perrin (2017) Perrin and Perrin (2017) 13 3/16/2021 AVA & APSAC publications 4. Coordinate medical, mental health & spiritual care 14 3/16/2021 Religion and Child Abuse Recommendations: - Foster respectful understanding between CACs and faith communities - Provide education to faith leaders - Train CAC staff on religious issues - Discuss religious issues in MDT case reviews (Tishelman & Fontes, 2017) Spirituality and trauma recovery Spirituality and ACEs 15 3/16/2021 Jouriles (2019) Gower (2020) APA Notes Importance of Spiritual Impact 16 3/16/2021 Julie Valentine Center Chaplain “Cultural competency is a fundamental component of the CAC philosophy… To effectively meet clients’ needs, the CAC and MDT must be
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