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New Report: Meaningfully address the impacts of adverse childhood experiences to reduce health care costs [www.tmc.edu]

Among the 8 solutions offered for reducing health care costs in a February white paper by the Texas Medical Center Health Policy Institute is the recommendation to meaningfully address the impacts of adverse childhood experiences .   

Childhood trauma is correlated with poor health outcomes – including early death. Early interventions to mitigate its effects are critical. Many studies show that childhood adversity is correlated with adult morbidity and mortality. Adverse childhood experiences (ACE) are traumatic or stressful events that occur before the age of 18 that can include abuse, neglect, sexual assault, household drug abuse or incarceration. According to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), adverse childhood experiences “are strongly related to the development and prevalence of a wide range of health problems throughout a person’s lifespan, including those associated with substance misuse.”

New data from the Robert Wood Johnson Foundation show that at least 38 percent of children in every state have had at least one ACE such as the death or jailing of a parent, seeing or being victim to domestic violence or living with someone who is suicidal or suffers from addiction. Nationally, 46 percent of U.S. youth have experienced at least once ACE.

Savings may result from social work programs that address the needs of those who’ve faced childhood trauma, such as positive parenting and enhanced family support. Addressing ACEs early is critical to reduce the rising cost of health care. A recent study in the UK found that individuals with at least four ACEs are at an increased risk of poor health outcomes. According to the study, risks “were strong for sexual risk taking, mental (illness) and problematic alcohol use, and strongest for problematic drug use and interpersonal and self-directed violence.”

The same study found that the effects were more pronounced on women, who had a 66 percent increased risk of early death with one adversity and 80 percent increased risk with two or more ACEs. 

Read the full report here

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I must say "politely" that this is all "very interesting" but ...

It does seem, now some two decades or more after the initial ACEs studies that, despite these studies being done in the health care field, very little, if anything of substance has yet been done that is of relevance. Perhaps, apart from early intervention into the lives of those children affected by ACEs -- and I'm not minimizing the tremendous economic importance and humanitarian value of such interventions -- the lives of the great majority of those affected so far (read "adults") do not seem to have been meaningfully improved in any way and, without reading the details, the specific recommendation "Empower patients to be responsible for their own health and health care" in itself does not seem to be likely to have any significant future import for "case management (or some other intervention", at least in the foreseeable future.  sfaik despite some past reassurances ACEsC itself does not have any particular special "health care" sub-group.

I think these "deficits" reflect the tremendous difficulties in conceptualising, and operationalizing, health care structures which could respond better to the challenges presented by the knowledge that childhood adversities contribute to the later, enduring, health problems suffered by those affected.

So far as I know, no one on this forum has mentioned a "recent" (in fact a continuation of studies' results from a few years ago) study showing that yet another negative health outcome from childhood adversities is (mature age) neurodegenerative diseases such as Parkinson's Disease -- my apologies, I have been meaning to write a post on this but ...  I have a personal stake in this -- having both a high ACEs score and recently diagnosed PD.

So, what is to be done? Been busy lately trying to make my own website 
"responsive" to try to get the word out -- and I have some ideas, but ...

Lots of "maybe's", but so far very little of substance in place, and still only nascent theories of etiology and means by which "resilience" may be improved -- that forthcoming post of mine?

There have also been some preliminary studies on Medi-Cal superusers (the 5% of the Medi-Cal population that accounts for 50% of the costs) that strongly suggests that ACEs feature strongly in their backgrounds. The idea is that case management (or some other intervention) with this group could improve outcomes and have a really significant impact on rising costs.

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