At the end of last year, the Michigan Association of Health Plans Foundation, MAHPF received a two-year grant from the Michigan Health Endowment Fund to support an initiative, “Creating Healing Communities: Addressing Adverse Childhood Experience in Michigan.” ACEs are serious childhood traumas that result in toxic stress which can damage the developing brain of a child and affect overall health. This toxic stress may prevent child from learning, from playing in a healthy way with other children, and can result in long-term health problems.
From the original research conducted by the Centers for Disease Control and Kaiser Permanente (San Diego), there are 10 ACEs that are grouped in the following areas: Abuse (Physical, Sexual, or Emotional); Neglect (Physical or Emotional) and Household Dysfunction (Mental Illness, Substance Abuse, Domestic Violence, Parental Separation/Divorce, Incarceration)
This research studied over 17,000 individuals at the Kaiser Permanente Health Plan in San Diego and the impact of various childhood adverse experiences in the context of their current health status. This study set in motion hundreds of additional research and related program initiatives continuing to this day. The 10 adverse childhood experiences are those listed in the illustration below and the percentages are those from the original study, but the recent survey in Michigan contains similar percentages.
Based on this research and supported by subsequent studies, populations with an ACE Score of 4 or more:
- Twice as likely to smoke
- Seven times more like to be alcoholics
- Six times more likely to have had sex before the age of 15
- Twice as likely to have been diagnosed with cancer
- Twice as likely to have heart disease
- Four times as likely to suffer from emphysema or chronic bronchitis
- Twelve times as likely to have attempted suicide
- Five times more likely to be involved in IPV or get raped
- Ten times more likely to have injected street drugs
- ACEs score of 8 gives four co-occurring problems
Fortunately, children are resilient—if given an opportunity—and that is the objective being pursued by the MAHP Foundation. Our failure to address ACE is being absorbed by the adult health care issues, costs and dysfunctions. By pursuing a comprehensive and long-term initiative to address ACE, Michigan can create change. The Michigan Association of Health Plans Foundation grant from the Michigan Health Endowment Fund launches that comprehensive effort. Under the Grant Award, the MAHP Foundation will:
- Increased and Sustained Awareness of Adverse Childhood Experiences (ACE) and impact on Michigan’s future health care, education, law enforcement.
- Regional Training that will produce a cohort of individuals qualified to link ACE Screening outcomes with community interventions.
- Continuing education opportunities for Michigan’s health providers to gain knowledge and skill
- Development and Implementation of State policy that will enable the use of the ACE screening tool as Children receive health screenings and services.
Dr. Robert Anda and Amanda Dubey-Zerka, LMSW at Master Training for ACE
This effort will be guided by a Michigan ACE Initiative Steering Committee composed of representatives from a broad array of health, education, and law enforcement organizations—including Cheryl Williams-Hecksel, Senior Clinical Instructor, Michigan State University, School of Social Work. Further involvement of the MSU School of Social Work has been the participation of Amanda Dubey-Zerka as part of the Master Training for ACE that took place in late September at the MSU Biological Station at Gull Lake. Additional Master training will take place next March (Plymouth Michigan at the Inn of St. John) and next September in Saginaw at the Central Michigan University Medical School annex adjacent to Covenant Hospital.
The cumulative effects of ACES reflect a powerful opportunity for prevention – no matter if you are working to prevent heart disease or cancer, end homelessness or hopelessness, or improve business profitability – as we align a portion of our work around a common goal of preventing the accumulation of ACEs and moderating their effects, we will reduce all of these problems, and many others, all at once!
The ACE Study is unique because it provides the potential to understand how multiple forms of childhood stressors can affect many important public health problems. Challenges to address population health, social determinants of health, disparities as well as the need to create integrated delivery systems are at the core of how ACE must be addressed in Michigan.