THE EXPANDED MODEL OF ADVERSE CHILDHOOD

EXPERIENCES…Sharon W. Cooper, MD FAAP

Developmental and Forensic Pediatrics, P.A.

Department of Pediatrics

University of North Carolina at Chapel Hill

School of Medicine

Womack Army Medical Center

Fort Bragg, NC

LEARNING OBJECTIVES

• Learn of the differences in the study population from the ACE study versus the Philadelphia Expanded ACE Study.

• Discuss the urban population experiences with an emphasis on the paucity of informed health care in these areas.

• Review strategies on how to advocate for children who have experienced expanded ACES.

EXPANDED ACES

• The original ACEs study focused on life experiences within the home/family

• Research revealed that ACEs were not predictive of expanded ACEs

• Recent studies include community-impact ACEs

(Cronholm et al., 2015)

In the American Journal of Preventive Medicine, Peter Cronholm and colleagues investigate whether Conventional Adverse Childhood Experiences (ACEs) alone can sufficiently measure adversity, particularly among various subgroups.

Current knowledge of childhood adversity relies on data predominantly collected from white, middle-/upper-middle-class participants and focuses on experiences within the home. Expanded ACEs were designed to capture unmeasured community-level experiences of socioeconomically and racially urban population. The researchers asked participants from a previous large, representative, community-based health survey in Southeast Pennsylvania to complete another phone survey measuring ACEs.

ACEs STUDY v EXPANDED ACEs STUDY

DEMOGRAPHIC

VARIABLES

ORIGINAL ACEs STUDY EXPANDED ACEs STUDY

MEAN AGE 56 34

RACE/ETHNICITY WHITE AMERICAN 79%

AFRICAN AMERICAN 5%

HISPANIC AMERICAN 5%

WHITE AMERICAN 42%

AFRICAN AMERICAN 43%

HISPANIC AMERICAN 12%

HIGH SCHOOL

GRADUATE

94% 36%

COLLEGE

GRADUATE

43% 13%

BELOW POVERTY

LEVEL

NOT MEASURED 25%

WHY THE PHILADELPHIA EXPANDED ADVERSE CHILDHOOD EXPERIENCES STUDY?

• The Philadelphia ACE Survey (2012-2013) was developed to understand the impact of community-level adversities.

• The research incorporated the Public Health Management Corporation’s Household Health Survey to survey 1784 adult participants in Philadelphia to add five additional community-level stressors.

• Ultimately a comparison report between the Kaiser Study, (1 Healthcare System), the CDC telephonic Behavioral Risk Factor Surveillance System (5 states) and Philadelphia Residents. The important outcome was the nature of additional adversity associated with growing up in an urban community.

ADDITIONAL VARIABLES IN EXPANDED ACEs

• Witnessing Violence

• Living in Unsafe Neighborhoods

• Experiencing Racism

• Living in Foster Care

• Experiencing Bullying

HEATHER HEYER

"If you're not outraged, you're not paying attention" was the last public Facebook post made by Heather Heyer.

The paralegal and Charlottesville native was killed after a car rammed into a group of protesters near a "Unite the Right" rally by White supremacist James Alex Fields, Jr.

Statement of Mr. David RitchesonHearing on H.R. 1592, the “Local Law Enforcement Hate CrimesPrevention Act of 2007”House Judiciary CommitteeSubcommittee on Crime, Terrorism, and Homeland SecurityTuesday, April 17, 2007

I appear before you as a survivor of one of the most despicable, shocking, and heinous acts of hate violence this country hasseen in decades. Nearly one year ago on April 22, 2006, I was viciously attacked by two individuals because of my heritage as a Mexican-American. After hanging out with a few friends at a local crawfish festival, my friend and I, along with the two individuals who would eventually attack me, returned to the home in Spring, Texas where I was to spend the night. It was shortly after arriving at this private residence that a minor disagreement between me and the attackers turned into the pretext for what I believe was a premeditated hate crime. This was a moment that would change my life forever. After I was surprisingly sucker punched and knocked out, I was dragged into the back yard for an attack that would last for over an hour. Two individuals, one an admitted racist skinhead, attempted to carve a swastika on my chest. Today I still bear that scar on my chest like a scarlet letter. After they stripped me naked, I was burned with cigarettes and savagely kicked by this skinhead’s steel toed army boots. After burning me in the center of the forehead, the skinhead attacker was heard saying that now I looked like an Indian with the red dot on my forehead. Moreover, the witnesses to the attack recalled the two attackers calling me a “wetback” and a ‘spic” as they continued to beat me as I lay unconscious. Once the attack came to an end, I was dragged to the rear of the back yard and left for dead. Reportedly, I lay unconscious in the back yard of this private residence for the next 8-9 hours. It was not until the next morning that I was found and the paramedics came to my aid. I am recounting this tragic event from the testimony I heard during the trial of the two attackers this past fall. God spared me the memory of what happened that night. As I sit before you today, I still have no recollection of those life changing twelve hours or the weeks that followed.

Teen victim of hate crime last year commits suicide

Originally published July 3, 2007 at 12:00 am Updated July 3, 2007 at 2:01 am

Ritcheson, 18, declined to get counseling after being attacked at the drug-fueled party in April 2006. A year later, he testified before Congress in support of a hate-crimes bill.

In an interview with the Houston Chronicle in April, he said: “I shouldn’t care what people think or say. It’s just the fact that everyone knows I’m the kid. It was bigger than Houston. It was bigger than Texas. It was bigger than America. Everybody in the world knew what had happened and everybody knew the details of it.”

Ritcheson, a Mexican American, was beaten and sodomized with a patio umbrella pole. He also was stomped and burned with cigarettes, and his attackers poured bleach on him before leaving him for dead. He was hospitalized for more than three months and endured 20 to 30 operations.

David Ritcheson, 18, committed suicide on Sunday by jumping off a cruise ship.

ADDITIONAL VARIABLES IN EXPANDED ACEs

• Witnessing Violence

• Living in Unsafe Neighborhoods

• Experiencing Racism

• Living in Foster Care

• Experiencing Bullying

CHILDHOOD ADVERSITY SHOULD BE FRONT AND CENTER IN OUR CLINICAL FAMILY HISTORY SO THAT WE CAN MEET AS MANY NEEDS FOR OUR PATIENTS AS POSSIBLE

Sharon_Cooper@med.unc.edu