1. Adverse Childhood Experiences
study and Domestic Violence
within the Asian American Pacific
Islander Community
An overview
Colette Katuala, LCSW
Owner, Focused Clinical Solutions
2. Adverse Childhood Experience study
(ACEs)
Kaiser’s weight loss study
Collaboration between Center for Disease Control and Prevention and
Kaiser to examine relationship between childhood and adolescent
traumatic experiences and future health outcomes
17,000 participants
10 categories measured
Each category rated equally,
added together to formulate ACE score
3. Findings - Prevalence
Presence of traumatic experiences in childhood more common than
thought
1/3 reported ACE score of zero
Of those reported presence of 1 category; greater chance there is a second
1 in 6 had score of 4 or more; 1 in 9 reported 5 or more
Women were 50% more likely then men to have experienced 5 or more
categories.
4. Implications on health
Presence of adverse childhood experiences have a cumulative effect
As ACE scores increased, as did chances for being a user of street drugs and abuse
alcohol
Remedies used placed them at higher risk for health and medical conditions
Relationship with medical diseases
5. Intervention
Trauma Informed care
Medical field to complete biopsychosocial assessments at onset of treatment
Medical workers become trained to illicit patients about their past trauma for
appropriate intervention and referral
Understand the stigma and shame associated with adverse childhood
experiences
6. Prevention
Social supports and strategies
Home visiting to pregnant women and families with newborns
Parent education programs
Parent support for teens and teen pregnancy prevention programs
Mental Illness and substance abuse treatment
High quality child care
Sufficient income support for lower income families
Intimate partner violence (DV) prevention
7. ACEs and Domestic Violence
Presence of adverse childhood experiences are associated with increased
likelihood of DV in adulthood
Female depression
Under-reporting of abuse
8. DV within the AAPI community:
literature review
Underrepresented in asking for DV services
Underreport IPV/DV victimization
Studies targeting Asian Women in America
9. Barriers to seeking formal supports
Taboo
Patriarchal systems
Family honor
Traditional family organization
Religion
Economic dislocation
Isolation
Lack of community consensus regarding DV
10. Call to Action
Community consensus condemning violence
Educate and Inform
Develop a community of helpers and supporters
Culturally congruent interventions
Further research targeted to Asian American communities
11. Thank you for your time and attention
Colette Katuala, LCSW
Focused Clinical Solutions
510-305-6656
focused.clinical@outlook.com
Editor's Notes
My discussion today will include an overview of the ACE study, its methods, findings, intervention strategies. I will then describe the relationship between adverse childhood experiences and domestic violence. I conclude my presentation by sharing the issue of DV within the AAPI community, the barriers that prevent women from seeking formal supports and possible interventions to address the issue.
Kaiser conducted a study of a weight loss program in the 80’s and found that participants who were successful at losing weight unexpectedly dropped out. After more exploration of those participants, they found that many used their weight was a shield against unwanted sexual advances or as a form of defense. Researchers discovered that many of the disengaged had suffered from physical and or sexual abuse as a child. Weight loss was physically and sexually threatening. The discussion emerged stating health problems, like obesity, were unconscious behaviors put in place as solutions to problems that commenced in childhood.
CDC and Kaiser – CDC with their skill set for study design and massive data management while Kaiser, for years, have carried out biopsychosocial evaluations of over 50,000 patients annually, were perfect authors and collaborators of this study.
From the 7th largest city in US, San Diego, middle class population – 80% White, including Hispanic, 10% Black, 10% identified as Asian American
emotional, physical , and sexual abuse; emotional and physical neglect, and household dysfunction relating to household member suffering from severe mental illness, alcohol and/or substance abuse and incarceration. Being raised by 1 parent and witnessing domestic violence as a child were also scoring indicators.
It appeared that categories were about equal to each other in impact, which was a surprise finding.
87% greater chance that a second was present
The relationship between adverse childhood experiences and depression was examined. They found that depression has deep roots, commonly from childhood; that on women, 54% of current depression and 58% of suicide attempts in women, have been attributed, at least in part, to traumatic experiences before they reached 18.
Compared to people with ACE scores of 0, those with 4 or more were 2x as likely to be smokers, 12x more likely to have attempted suicide, 7x more likely to be alcoholic, and 10x more likely to have injected street drugs.
Common contemporary health risks including smoking, alcoholism, illicit drug use, obesity and high level promiscuity, all of which are harmful to health and difficult to give up because they have the short term benefit in dealing with emotional pain.
COPD, Liver disease and heart disease rates at least doubled when there was presence of 4 or more categories of childhood trauma.
It as also found that people with a score of 6 or more, died, on average 20 years earlier than those with scores of zero.
The study looked at the relationship between DV and adverse childhood experiences.
Partially through psychosocial outcomes such as depression, anxiety, PTSD, impulsivity, and problem drinking
The study proved that depression was a pathway between ACEs and DV ( in male/female relationships)
DV is highly correlated to all adverse childhood experiences except having a family member in prison.
Studies have shown that women are reluctant to disclose abuse as well as the provider being reluctant to ask. This is due to various factors including lack of training and confidence of providers regarding discussions of the subject, fear of offending patient, language barriers and cultural issues.
A study of 8000 men and 8000 women from all ethnic backgrounds. Asian Americans reported lower rates than any other ethnicity. 12% physical and 3 % sexual abuse (raped) by their intimate partners. 26% for Blacks, 21% Hispanics, 21% for Whites, and 30% of people who identify as Native American reported abuse within their current intimate relationships. The stark difference begs the question as to why.
One study, conducted by Project AWARE (Asian Women Advocating Respect and Empowerment) conducted a study in 2000/01 using a snowball method and found that of the 178 Asian Women surveyed, 81% experienced at least 1 form of DV in the past year, 67% occasionally experienced some form of domination/controlling or psychological abuse, 48% experienced it frequently in the past year.
32% experienced physical/sexual abuse occasionally in the past year. Of the women who reported no domestic violence, 64% knew of an Asian friend who experienced DV, 28% knew of an Asian woman being abused by her in-laws- half of which said in-law abuse are both common and very common problems facing Asian American women.
In 2005 – NAWHO, National Association of Asian Women’s Health Organization completed telephone interviews of AA women in SF and LA and found that 16% were pressured to have sex without consent with their intimate partner and 27% reported emotional abuse.
A fact sheet put out by the Asian and Pacific Islander Institute on DV based out of SF cited in 2012 that between 41-61% of Asian Women report experiencing physical and/or sexual violence by an intimate partner in their lifetime
IN general, it is found that the problems categorized in the ACE study are shielded by social taboos against freely discussing topics, even in medical settings. Within AAPi communities, the shame of reporting feels even greater. Studies have shown that in South Asian communities, female children and adolescents are not to openly discuss sexuality to parents or at school.
There is a known social stigma to disclose abuse within community, even close friends. Divorce is taboo. Many current formal DV interventions support leaving the abuser instead of staying and stopping the violence.
Within most AAPI cultures, there are gender asymmetrics, families in which the power structure begins with the father, then elder male, son, then females who hold the bottom spot of the family system in terms of rights and decision making capacity all of which give rise to abuse.
Women’s role within Asian American family include the expectation of upholding family honor, that family peace and outcome is of greater importance than individual needs. The responsibility for family harmony incentivizes silence around domestic violence.
Women are taught that they must endure pain, remain nurturing and forgiving.
Traditional family organization means that family and community life take priority over personal safety
Hinduism and Islam support the oppression of women, these religions do not support divorce
Women have stated that they are willing to stay in abusive relationships for the educational outcomes of their children
Acculturation issues – 50% of Asian Americans in US are foreign born
Fear to report include immigration status, language access, economic dependence support the subjugation of immigrant women in America. American values and interventions come in conflict with Asian American cultural belief systems.
Clear message that violence against women is wrong. Women surveyed stated that they did not believe DV was wrong It has been found that women who believe that DV is wrong, are more likely to reach out for support. Community, religious leaders and men must be at the forefront of changing the attitudes about violence against women. Make unspeakable, speakable. Concrete efforts to get them talking about it – focus groups, meetings, and trainings within the community to promote a more open mindset
Educate the community about the impact of family violence and provide women with knowledge of resources will support the treatment and prevention of DV. Discovery of their options have led to increased engagement of formal supports.
Build social networks within the woman’s community, strengthen informal supports by working with extended family to become allies instead of bystander or colluder.
Have programs and services geared toward upholding family cohesiveness
Community based treatments that capitalize on values and strengths common to AAPI communities like peaceful home campaigns inclusive of harmony and peace values.
Formal supports to focus on keeping family intact, working with families and extended members to support the ending of violence.
½ of the AA population resides in 5 states, and ¾ reside in 10 states in the US. Conduct studies in those concentrated areas to obtain the most representative view of the problem and to focus interventions in areas of greatest need.
