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Priority Area 5: Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are traumatic events and include physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, intimate partner violence, substance misuse within the household, household mental illness, parental separation or divorce, and having an incarcerated household member. The harmful effects of ACEs on health status throughout the lifespan have been well documented.

Studies have shown an association between ACEs and chronic disease, behavioral health issues, and initiation of risky health behaviors. Studies have also documented a dose-response relationship between ACEs and adverse health and behavioral health outcomes, meaning that persons with more ACEs (a higher ACE score) are more likely to have more adverse health outcomes. A recent systematic review and meta-analysis of the published literature on ACEs indicated that persons with four or more ACEs were at increased risk for all negative health outcomes examined in the study. The strongest associations were found with problematic drug use, interpersonal and self-directed violence, sexual risk taking, poor mental health, and problematic alcohol use, followed by moderate associations with smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease. While considered weak or modest, associations were nonetheless documented with physical inactivity, overweight or obesity, and diabetes.

Since multiple ACEs can be considered a major risk factor for many health conditions, a public health approach to ACEs and childhood trauma is warranted. While clinical treatment of psychological trauma is well-established, population-based strategies for prevention are still emerging. Recognizing ACEs/trauma informed strategies need to be applied across the health priorities addressed in this plan, the State Health Improvement Coalition determined this special section of the plan should describe key cross-cutting strategies.

Every effort should be made to support populations that are potentially disproportionately affected by this issue. In 2011, 60% of Montana adults reported having one or more ACEs. A higher percent of American Indian than white non-Hispanic adults reported experiencing four or more ACEs, as did adults who had not completed high school compared to those who had more education, adults with lower annual incomes compared to those with higher incomes, and adults with disabilities compared to those without disabilities.

ACEs are the SHIP cross-cutting strategy. The bulk of the conversation about ACEs will take place within the Healthy Mothers, Babies, and Youth workgroup, although all workgroups will have opportunities to discuss how ACEs impact their work.