DefinitionPercentage of adults 18 years of age and older who responded "Once" or "More than once" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "How often did ANY of the following events apply to you: You didn't have enough to eat, you had to wear dirty clothes, or you had no one to protect you?"
NumeratorWeighted number of adults (18+) who responded "Once" or "More than once" on the BRFSS to the question: "How often did ANY of the following events apply to you: You didn't have enough to eat, you had to wear dirty clothes, or you had no one to protect you?"
DenominatorWeighted number of adults (18+) who responded to the physical neglect question on the BRFSS, excluding those with missing or "Refused" responses. Those who responded "Don't know/Not sure" are defined as a negative response for that ACE category.
Data Interpretation IssuesThe preamble to each of the Adverse Childhood Experiences (ACEs) question was: "I'd like to ask you some questions about events that happened during your childhood. This information will allow us to better understand problems that may occur early in life, and may help others in the future. This is a sensitive topic and some people may feel uncomfortable with these questions. At the end of this section, I will give you a phone number for an organization that can provide information and referral for these issues. Please keep in mind that you can ask me to skip any question you do not want to answer. All questions refer to the time period before you were 18 years of age. Now, looking back before you were 18 years of age ---"
While the individual adverse childhood experience (ACE) an Alaska adult may have experienced is important, the strength of the research lies in the often multiple ACEs an individual has during childhood: "The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a graded dose-response relationship between ACEs and negative health and well-being outcomes across the life course...Dose response describes the changes in an outcome (e.g., alcoholism) associated with differing levels of exposure (or doses) to a stressor (e.g., ACEs). A graded dose-response means that as the dose of the stressor increases the intensity of the outcome also increases."^1^
The ACEs question on physical neglect was asked in 2014 and 2015.[[br]]
1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016.}}
Why Is This Important?Physical neglect is common but difficult to identify. Failure or refusal to provide physical necessities endangers the child's physical health, well-being, psychological growth, and development. Physical neglect can severely impact a child's development by causing failure to thrive; malnutrition; serious illness; physical harm in the form of cuts, bruises, burns, or other injuries due to the lack of supervision; and a lifetime of low self-esteem.^2^ The impacts of overwhelming stress on the brain continue into adulthood and can have generational impacts. As Alaska children exposed to physical neglect grow up, they may find negative ways to cope with their damaged stress responses. Adverse Childhood Experiences (ACEs) are potent risk factors for later involvement in domestic violence, alcohol dependence, and suicide attempts. When children exposed to physical neglect mature into adults and start families of their own, these behaviors can become ACEs for another generation.^3^
The Adverse Childhood Experiences (ACE) Study, a collaborative between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego, assessed associations between childhood maltreatment and later-life health and well-being.^1^ It is critical to understand how some of the worst health and social problems can arise as a consequence of adverse childhood experiences. Sixteen of the [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] measures have been shown through peer-reviewed journal articles to be negatively impacted by adverse childhood experiences. Alaska takes on the burden of approximately $82 million in costs (e.g., health care costs, welfare costs, special education costs) each year due to nonfatal child maltreatment. Realizing these connections is likely to improve efforts towards prevention and recovery.^4^[[br]]
1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016.
2. American Humane Society. Chronic child neglect - understanding the definition and impact of neglect. [http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-neglect.html]. Accessed April 26, 2016.
3. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Investing in prevention: working together in early childhood for healthy Alaskan children, families, and communities 2015. [http://dhss.alaska.gov/abada/aceak/Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016.
4. Sidmore P. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Economic costs of adverse childhood experiences in Alaska. [http://dhss.alaska.gov/abada/ace-ak/Documents/ACEsEconomicCosts-AK.pdf]. Accessed April 26, 2016.
How Are We Doing?In 2014 and 2015 combined, 11.1% of Alaska adults reported having experienced childhood physical neglect. Those adults who were college graduates reported significantly lower prevalence of physical neglect at 8.4% than those who had less than a high school education at 15.4%. Employed adults had a prevalence of 10.2% having been physically neglected but those unable to work reported a significantly higher exposure at 28.8%. There was also a significant difference in exposure to physical neglect among adults with different incomes - those making less than $15,000 reported 19.2%, while those making more than $75,000 reported 9.7% experiencing physical neglect.
Rates of physical neglect during childhood from the BRFSS are initially presented for all Alaskans and Alaska Native people for the combined 2-year period from 2014-2015. Subsequent analyses were conducted for demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status).
Crosstabulations were also conducted for 2-year averages by body mass index, current smoking, sexual orientation, and disability. Significant differences were evident in current smoking, sexual orientation, and disability rates.
Rates of physical neglect during childhood by regions of Alaska are presented for all Alaskans and Alaska Native people for the 2-year average of surveys conducted between 2014-2015: 1) 7 Alaska Public Health Regions, 2) 5 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) 29 boroughs and census areas, and 5) 12 tribal health organization regions.
How Do We Compare With the U.S.?There are no national statistics on physical neglect available.
What Is Being Done?Poverty plays a substantial role in child physical neglect. [http://dhss.alaska.gov/dpa/Pages/atap/default.aspx Alaska Temporary Assistance Program (ATAP)] provides cash assistance and work services to low-income families with children to help them with basic needs while they work toward becoming self-sufficient.^5^ The [http://dhss.alaska.gov/dpa/Pages/nutri/wic/participants/wicprogramoverview.aspx Women, Infants, and Children program (WIC)] also provides checks that help pregnant women, new mothers, and young children eat well.^6^
The [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] initiative developed strategies by content experts to reduce child maltreatment. Public health partners around the state are aligning work around these approaches adapted by Alaska's unique needs. Alaska strategies include:
1. Promote screening and monitoring for child abuse in primary care offices and public health clinics.
2. Use the [http://www.cssp.org/reform/strengtheningfamilies Strengthening Families Protective Factors] framework in family programs.
3. Expand home visiting programs.
4. Expand and strengthen quality early childhood programs.
5. Train providers on brain development, adverse childhood experiences (ACEs), and resiliency.^7^
Alaska has many groups working on preventing childhood trauma and easing the effects of damage already done. Here are a few examples (as of early 2015):^8^
Statewide, teachers and public health nurses provide teens with information on healthy relationships and life skills. They have partnered with the Alaska departments of Health and Social Services and Education and Early Development, the [http://www.dps.alaska.gov/cdvsa/ Council on Domestic Violence and Sexual Assault], and the [http://www.andvsa.org/ Alaska Network on Domestic Violence and Sexual Assault] on an evidenced-based curriculum for the 7th-9th grade called [https://education.alaska.gov/tls/schoolhealth/fourth.html "the Fourth R for Healthy Relationships."]
The Division of Public Health partnered with the Alaska Native Tribal Health Consortium and the [http://dhss.alaska.gov/dph/chronic/pages/injuryprevention/akfvpp/default.aspx Alaska Family Violence Prevention Project] to develop a teen safety card, a gender-neutral resource developed for Alaska teens with guidance from Alaska teens. The card provides information about healthy and unhealthy relationship characteristics, what consent looks and sounds like, and where to get help, if needed. Another safety card was designed specifically for women.^9^
The Division of Behavioral Health has promoted trauma-informed care for several years. Efforts include development of "Trauma 101" and "Trauma 201" curriculum for behavioral health providers, used around the state.
[http://tundrapeace.org/programs/taav/ Teens Acting Against Violence (TAAV)] is a violence-prevention and youth empowerment program at the [http://tundrapeace.org/ Tundra Women's Coalition] for teenagers living in Bethel. Participation is voluntary and open for any interested teens age 12-18.^10^[[br]]
See "References and Resources" section for references.
Evidence-based PracticesRecovering from trauma is a challenging process. Building resiliency and having a supportive adult in your life can help with recovery. Positive experiences - such as exposure to environments rich in a range of developmentally appropriate opportunities for social play and exploration - can compensate for and even reverse the negative consequences of stress Efforts during childhood are essential because over time, some stress-induced detriments are increasingly resistant to reversal.
Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment approach shown to help children, adolescents, and their caregivers overcome trauma-related difficulties. It is designed to reduce negative emotional and behavioral responses following traumatic events. The treatment - based on learning and cognitive theories - addresses distorted beliefs and attributions related to the abuse and provides a supportive environment in which children are encouraged to talk about their traumatic experience. TF-CBT also helps parents who were not abusive to cope effectively with their own emotional distress and develop skills that support their children.^11^
ACEs are best addressed through a coordinated effort to implement prevention programs across multiple settings and populations. Research indicates the majority of health and social challenges are interconnected and often share the same root causes. The following steps need to be taken to address these root causes:
1. Support quality early childhood programs.
2. Ensure access to health care including behavioral health care.
3. Strengthen capacity for social emotional learning throughout Alaska's schools.
4. Maintain and expand prevention efforts that have proven to be effective.^3^
The [http://www.cssp.org/ Center for the Study of Social Policy] spent two years researching and identifying five protective factors that prevent child abuse and neglect. These are: parental resilience, social connections, concrete support in times of need, knowledge of parenting and child development, and social and emotional competence of children. Research studies support the common-sense notion that when these protective factors are well established in a family, the likelihood of child abuse and neglect diminishes. Research shows that these protective factors are also "promotive" factors that build family strengths and a family environment that promotes optimal child and youth development.^12^[[br]]
3. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug
Abuse. Investing in prevention: working together in early childhood for healthy Alaskan children, families, and communities 2015.
[http://dhss.alaska.gov/abada/ace-ak/Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016.
11. Child Welfare Information Gateway. Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or
trauma. [https://www.childwelfare.gov/pubPDFs/trauma.pdf]. Accessed April 26, 2016.
12. Alaska Department of Health and Social Services. Office of Children's Services. Strengthening families.
[http://dhss.alaska.gov/ocs/Pages/families/default.aspx]. Accessed April 26, 2016.