Shaping adults

Four aces typically make a winning hand in poker. Four ACEs in life, however, means the deck is stacked against you.

ACE stands for Adverse Childhood Experience. Researchers have identified 10 exposures—abuse, neglect, traumatic household disruptions—that represent risk factors for addiction, violence, criminal behavior and chronic health conditions later in life.

The issue is close to home. According to a report recently released by the Center for Youth Wellness, Butte County ranks first in California for ACE exposure: 76.5 percent of residents have at least one.

The more ACEs, the greater the jeopardy.

“More people in Butte County have four or more ACEs, which is kind of like the tipping point,” said DeAnne Blankenship, Chico-based director of program services for the nonprofit California Health Collaborative. “Four or more ACEs put you at considerably higher risk for all kinds of things: substance abuse, alcoholism … chronic disease as well.”

The report, A Hidden Crisis: Findings on Adverse Childhood Experiences in California, finds that a person with four or more ACEs is twice as likely to have cancer and/or heart disease, three times as likely to smoke and/or binge drink, five times as likely to suffer from depression, seven times as likely to be an alcoholic, 10 times as likely to inject drugs and 12 times as likely to attempt suicide.

“Some people are like, ‘Duh,’ but others are really enlightened by this,” Blankenship said. “No matter what you do as an adult, the research is showing that a lot of these conditions that you may suffer from are dictated by your exposure to trauma as a child.

“Trauma doesn’t have to mean you were molested. It could mean that; but it also has lots of other [meanings]. It could be neglect. It could be a parent was incarcerated. It could be a parent had a mental illness.”

The 10 ACEs are common denominators researchers found to be connected to risk factors for myriad conditions during a 1997 study of 17,000 Californians conducted by Kaiser Permanente in conjunction with the federal Centers for Disease Control and Prevention.

Mitch Brown, director of training for the Drug Endangered Children Training and Advocacy Center (or DECTAC), compares the cumulative effect of multiple ACEs to a water skier on a lake. Forgoing a life jacket, for instance, doesn’t necessarily translate into tragedy. However, if the flotation-free skier has been drinking alcohol, the chances of misfortune escalate. If the boat operator is also drunk, even more so.

“Risk factors don’t mean it’s going to happen,” Brown explained, “but they mean we need to look at you and try to prevent you from hurting yourself or others from hurting you.”

In an effort to proactively address the ACE problem, a host of North State agencies, including the California Health Collaborative and DECTAC, have joined forces.

After training public health providers in Shasta County on ACEs—helping them become “trauma-informed”—Blankenship and several colleagues decided to organize similar sessions here. Their first planning meeting yielded the revelation that “this subject crosses all segments of the population,” she said. “Now we’re looking beyond health care-provider training.”

The second meeting drew 30 attendees working in law enforcement, social services, education and health. The group hopes to attract clergy as well during the next meeting on Dec. 4.

The goal is to form a tapestry of referral services along with informing the public about ACEs.

“There’s work in small pockets on a specific topic,” Blankenship explained, such as domestic abuse and substance abuse. But linking them all together, she said, would be a significant step.

Blankenship added that, for adults, it’s never too late to understand how childhood affects adulthood. “It’s educational [to know] there are things that have shaped me as a person, that I have some resilience—but I might also have some risk factors, some things that I want to take a look at so I make sure I’m modeling proper behavior for my children.”

The consequences of ACEs are significant. Brown surveyed drug offenders in Butte County Jail for a pilot program called Perils of Drug Use—Walk with Me stemming from state corrections legislation AB 109. He found that 51 percent were exposed to at least four ACEs, compared to 12 percent of the general population in the original ACEs study from 1997, and the incidence of each ACE was much higher among the offenders (see chart).

“All the various disciplines have a piece of the puzzle to make children and families better off by providing them early services and not waiting for catastrophes to happen,” Brown said, adding, “We can’t really think we’re helping people if we’re only addressing one of the 10 issues, and we know they have more than that.

“We’re putting a frigging Band-Aid on it with no chance of success, as far as I’m concerned, without having a holistic approach.”