ACES and Homelessness


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Webinar presented by Heather Larkin, Associate Professor at the SUNY Albany School of Social Work, on the Adverse Childhood Experiences Study and ACES impact on homeless individuals.

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ACES and Homelessness

  1. 1. Adverse Childhood Experiences (ACE) Research: Extension, Integration & Implications Heather Larkin, MSW, PhD Assistant Professor, University at Albany
  2. 2. The Adverse Childhood Experiences Study <ul><li>The largest study of its kind ever done to examine the health and social effects of adverse childhood experiences over the lifespan (Felitti & Anda) </li></ul><ul><li>Experiences while growing up that deeply impact a young person and profoundly affect emotional and physical health later in life. </li></ul><ul><li>(Thank you to Vincent Felitti for slides) </li></ul>
  3. 3. Categories of Adverse Childhood Experiences <ul><li>Abuse, by Category Category </li></ul><ul><li>Prevalence (%) </li></ul><ul><li>Psychological (by parents) 11% </li></ul><ul><li>Physical (by parents) 11% </li></ul><ul><li>Sexual (anyone) 22% </li></ul><ul><li>Household Dysfunction, by Category </li></ul><ul><li>Substance Abuse in family 26% </li></ul><ul><li>Mental Illness in family 19% </li></ul><ul><li>Domestic Violence 13% </li></ul><ul><li>Imprisoned Household Member 3% </li></ul><ul><li>Loss of parent 23% </li></ul>
  4. 4. Adverse Childhood Experiences Score Number of categories of childhood experiences are summed ACE Score Prevalence 0 48% 1 25% 2 13% 3 7% 4 7% <ul><li>More than half have at least one ACE </li></ul><ul><li>Slightly more than one quarter have experienced </li></ul><ul><li>2 – 4 ACE categories </li></ul>
  5. 5. <ul><li>The Adverse Childhood Experiences (ACE) Study </li></ul><ul><li>Summary of Findings: </li></ul><ul><li>Adverse Childhood Experiences (ACEs) are very common </li></ul><ul><li>ACEs are strong predictors of adult health risks and disease </li></ul><ul><li>ACEs are implicated in the 10 leading causes of death in the U.S.! </li></ul><ul><li>“ I was actually stunned and I wept over what I saw.” ACEs researcher Rob Anda, M.D. </li></ul><ul><li>Virtually every study shows that ACEs are strong predictors of homelessness (Burt, 2001) </li></ul>
  6. 6. Adverse Childhood Experiences and Current Smoking %
  7. 7. Childhood Experiences and Adult Alcoholism 0 1 2 3 4+
  8. 8. Childhood Experiences Underlie Chronic Depression
  9. 9. Childhood Experiences Underlie Suicide 1 2 0 3 4+
  10. 10. ACE Score Ever Hallucinated* (%) Abused Alcohol or Drugs *Adjusted for age, sex, race, and education. ACE Score and Hallucinations
  11. 11. ACE Score and Intravenous Drug Use N = 8,022 p<0.001
  12. 12. ACE Score and Serious Job Problems
  13. 13. Birth
  14. 14. A Connection with Homelessness <ul><li>Mental illness and substance abuse problems are more common among homeless people </li></ul><ul><li>ACEs connection to substance abuse and mental illness </li></ul><ul><li>Even non-homeless people with either substance abuse problems or mental illness are less likely to hold a job </li></ul>
  15. 15. UAlbany SSW: ACEs & Homeless People <ul><li>The problem addressed in this proposal concerns the difficult nature of homelessness, its human and economic costs, and its uncertain origins </li></ul><ul><li>Importance of the social work perspective </li></ul>
  16. 16. ACE & Homelessness <ul><li>Prevalence of ACEs among the homeless population. </li></ul><ul><li>Length of stay in programs, reasons people give for leaving the program, and service utilization history </li></ul><ul><li>Measures of mental health symptoms and substance use </li></ul>
  17. 17. ACE & Homelessness <ul><li>Clarify the role of ACEs among homeless people </li></ul><ul><ul><li>Future intervention research </li></ul></ul><ul><li>Service utilization history </li></ul><ul><ul><li>Prevention of homelessness </li></ul></ul>
  18. 18. University at Albany School of Social Welfare: ACE Response <ul><li>Enhance our understanding of ACEs </li></ul><ul><li>Integrate with literature on resiliency and protective factors </li></ul><ul><li>Prevention and Intervention for each ACE outcome </li></ul><ul><li>Support systems transformation </li></ul>
  19. 19. Person-in-Environment: A complex interplay of risk and resources <ul><li>ACE impact on Health Risk Behaviors </li></ul><ul><li>developing self (substance abuse, sexual </li></ul><ul><li>(overwhelming feelings, and other risk-taking, etc.) </li></ul><ul><li>activation of defense Medical problems (both </li></ul><ul><li>mechanisms, etc.) short & long-term) </li></ul><ul><li>Changes in developing brain </li></ul><ul><li>INDIVIDUAL </li></ul><ul><li>COLLECTIVE </li></ul><ul><li>Family meanings Family relational system/ACEs </li></ul><ul><li>Cultural values Social violence </li></ul><ul><li>Social taboos Health, Mental health, & Substance abuse services </li></ul><ul><li>Victim blaming Social service , school, & criminal justice systems </li></ul><ul><li>“ rugged individualism” Public health policy responses </li></ul><ul><li> </li></ul>
  20. 20. Development, behavior, health, culture, and systems <ul><li>Developmental theorists (Piaget, Kohlberg, Gilligan, Loevinger, Freud, and others) </li></ul><ul><li>Impact of ACEs and health risk behaviors on development </li></ul><ul><li>The role of culture and social systems </li></ul><ul><li>Service interventions that prevent or effectively treat ACEs sooner might prevent homelessness (& other serious health and social outcomes) later in life </li></ul>
  21. 21. ACE & Homelessness Findings <ul><li>More than 85% of respondents reported at least one of the 10 adverse childhood experiences and more than half (52.4%) experienced more than 4 ACEs </li></ul><ul><li>More than half (55.1%), suffered the loss of a biological parent, followed by a lack of family support growing up (51.9%) and living in a home with a substance abuser (50.3%) </li></ul><ul><li>More than half of respondents (51.4%) report having experienced verbal abuse and 22.2% report they did not receive the proper care growing up. More than a third (40.5%) of homeless respondents suffered physical abuse by a parental figure. Over a quarter of respondents (29.7%) had a sexual abuse background </li></ul>
  22. 23. Key Milestones <ul><li>Felitti and Anda visits – 2007, 2008, 2009 </li></ul><ul><li>Policy Lunch – May 2009 </li></ul><ul><li>Council on Children and Families – June 2009, September 2009 </li></ul><ul><li>ACE Think Tank and Action Teams </li></ul><ul><ul><li>Rob Anda, Vincent Felitti, Fred Bolton </li></ul></ul><ul><li>ACE Steering Committee </li></ul><ul><li>NYS Omnibus Survey </li></ul><ul><li>Multi-state ACE Learning Community </li></ul>
  23. 24. Planned NYS Omnibus Survey <ul><li>ACE Questions </li></ul><ul><li>800 NYS residents over 18 years </li></ul><ul><li>demographic factors </li></ul><ul><ul><li>age, education, household income, gender, marital and family status, geographic region, partisan affiliation, race and ethnicity </li></ul></ul><ul><li>Move toward ongoing BRFSS ACE data collection as policy tool </li></ul>
  24. 25. Implications <ul><li>ACE Response: Fostering resilience & mobilizing protective factors </li></ul><ul><li>Workforce development </li></ul><ul><li>Practice, programs, policies that take trauma into account </li></ul><ul><li>Cross-system linkages/ service integration </li></ul><ul><ul><li>(TRANSFORMATION) </li></ul></ul>