Magazine article Corrections Today

ACEs High: The Impact of ACEs on Health Care Costs-How Parenting Classes at a Tennessee Prison Are Breaking the Cycle

Magazine article Corrections Today

ACEs High: The Impact of ACEs on Health Care Costs-How Parenting Classes at a Tennessee Prison Are Breaking the Cycle

Article excerpt

A 3-year-old boy named Anthony gets up at 6 a.m., walks to the kitchen and tries to find something to eat. Cockroaches scatter as he turns on the light. His mother is in a deep sleep after a late night of drinking, drugging and physical fighting with her boyfriend. Anthony stayed awake through it all, experiencing a living nightmare. He's had only four hours of sleep; he will take care of himself for the next five hours until his mom wakes up. Anthony was born an unwanted child to a 19-year-old mother, who was often high on drugs or depressed. On the day of his birth, his father was serving time, leaving his mother as a single parent. Anthony needed what every baby needs: comfort, snuggles, smiles and engagement. Instead, he was ignored. Why should Anthony matter to an outsider?

In the late 1990s, the Centers for Disease Control (CDC) and Kaiser Permanente conducted a landmark study called the Adverse Childhood Experiences (ACE) study. Over 17,000 members of Kaiser Permanente were surveyed. (1) This research captured the strong relationship between child abuse and neglect and the costly, lifelong social, emotional and physical health problems. The study highlights 10 types of adversity children might experience, including physical, emotional or sexual abuse; physical or emotional neglect; mental illness; an incarcerated family member; witnessing substance abuse or domestic violence; and divorce. Ten short questions provide an ACE score between zero and 10. The higher the score, the more likely that person is to experience disease, social problems and early death. Science now shows that the reason abuse, neglect and family dysfunction impact lifelong health and well-being in such extreme ways is a result of constant stress, which is toxic and damaging to developing brains and bodies. Brain development in children like Anthony is compromised; specifically, the parts of the brain responsible for learning, memory, emotional control, planning, understanding consequences and thinking abstractly are all underdeveloped.

In the 15 years since the original study, over 70 additional research papers on ACEs have been published. Presence of child adversity has a strong relationship to social issues, mental health and physical diseases, including heart disease, depression, diabetes, teen pregnancy, substance abuse, violence, cancer, stroke, chronic obstructive pulmonary disease (COPD), alcoholism, divorce, liver disease, academic failure, smoking, obesity, domestic violence and absence from the work force.

If we follow Anthony through his life, we see him begin his first day of kindergarten already behind. He has problems with learning and memory and doesn't know how to get along with other children. School reinforces to him how unlikeable, unwanted and stupid he feels. At 10, he is failing school and getting expelled for aggressive behavior. At 11--still a child--he begins smoking and using drugs to cope with his ever-present stress. At 14, he begins selling drugs and, at 16, sells to his father for the first time. By age 20, he is incarcerated on charges of possession for the second time and has never held down a job. At 45, his chronic diseases, such as diabetes, heart disease and COPD, lead to frequent and expensive use of the health care system. Sadly, his three children are experiencing the same adversity he did as a child: the lack of a safe, stable and nurturing home.

While incarcerated at a Tennessee jail, Anthony takes a parenting class which teaches inmates about the ACE study. Anthony completes the questionnaire and identifies seven ACEs. For those who are incarcerated, Anthony's score of seven is the rule rather than the exception.

The Family Center, a child abuse prevention agency serving middle Tennessee, targets vulnerable parents like Anthony who are incarcerated, in substance abuse recovery and/or involved with the legal system. After administering almost 400 ACE questionnaires during parenting classes in three different jails, the results showed those who are incarcerated have experienced considerably more child trauma than the general population. …

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