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State of Alaska

Health Indicator Report of Adverse Childhood Experiences: Witnessed Domestic Violence

Although awareness about the rate of domestic violence in our society is increasing, the public health response has largely focused on mitigating the effect of violence on the primary victim. There is also a large negative effect on secondary victims, such as children who live in homes where domestic violence occurs. It is estimated that 3.2 million American children witness incidents of domestic violence annually.^2^ The emotional toll on children who witness domestic violence can be substantial, especially when those involved are familiar to the child and the violence takes place in the home. Current research has found that children exposed to domestic violence are at an increased risk for emotional and behavioral problems, including anxiety, depression, and academic problems.^3^ In one study, 40% had lower reading abilities than children from non-violent homes.^4^ Some studies suggest social development is also damaged. Some children lose the ability to feel empathy for others. Others feel socially isolated, unable to make friends as easily due to social discomfort or confusion over what is acceptable. Many studies have noted that children from violent homes exhibit signs of more aggressive behavior, such as bullying, and are up to three times as likely to be involved in fighting.^5^ The impacts of overwhelming stress on the brain continue into adulthood and can have generational impacts. As Alaska children who have witnessed domestic violence grow up, they may find negative ways to cope with their damaged stress responses. When as adults they start families of their own, these behaviors can become Adverse Childhood Experiences (ACEs) for another generation.^6^ The single best predictor of children becoming either perpetrators or victims of domestic violence later in life is whether or not they grow up in a home where there is domestic violence. Studies from various countries support the findings that rates of abuse are higher among women whose husbands were abused as children or who saw their mothers being abused.^7^ Intimate partner violence can disrupt many protective factors and increase the probability of offspring involvement with child welfare as adults resulting in the intergenerational transmission of trauma.^8^ 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 (i.e., 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.^9^[[br]] [[br]] ---- {{class .SmallerFont See the "Resources and References" section for references. }}

Notes

Alaska Native people refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals of multiple races incorporating American Indian/Alaska Native are moved into the Alaska Native group. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class. The definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Interpretation Issues

The 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 of witnessing abuse of parents or adults was asked from 2013 through 2015.[[br]] [[br]] ---- {{class .SmallerFont 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.}}

Definition

Percentage 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 your parents or adults in your home ever slap, hit, kick, punch, or beat each other up?"

Numerator

Weighted number of adults (18+) who responded "Once" or "More than once" on the BRFSS to the question: "How often did your parents or adults in your home ever slap, hit, kick, punch, or beat each other up?"

Denominator

Weighted number of adults (18+) who responded to the witnessed abuse 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 ACEs category.

How Are We Doing?

In 2013-2015 combined, 18.6% of Alaska adults reported having witnessed abuse at home during their childhood; the prevalence for exposure to this abuse for Alaska Native adults was much higher at 31.2%. Those adults who were college graduates reported significantly lower levels of witnessing abuse at 13.6% than those who had less than a high school education at 26.0%. Employed adults reported 17.8% had witnessed abuse - those unemployed and unable to work reported significantly higher prevalences of 24.7% and 30.0%, respectively. There was also a significant difference among adults with different incomes - those making less than $15,000 reported exposures of 29.3%, while among those making more than $75,000 15.1% reported witnessing abuse. Rates of exposure to domestic abuse during childhood from the BRFSS are initially presented for all Alaskans and Alaska Native people for the combined 3-year period from 2013-2015. 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 3-year averages by body mass index, current smoking, sexual orientation, and disability. Significant differences were evident in contrasts by current smoking, sexual orientation, and disability. Rates of exposure to domestic abuse during childhood by regions of Alaska are presented for all Alaskans and Alaska Native people for the 3-year average of surveys conducted between 2013-2015: 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 ACEs available; however, in 2009 the CDC released a study comparing ACEs data from 5 states (i.e., Arkansas, Louisiana, Tennessee, New Mexico, Washington) that used the BRFSS ACEs module. When compared to the 5 states, Alaska adults reported higher than the mean of the total states and was the second highest in rates of adults who had witnessed abuse at home.^10^ Compared to data from adults who witnessed abuse at home during their childhood from the 10 states (i.e., Hawaii, Maine, Nebraska, Nevada, Ohio, Pennsylvania, Utah, Vermont, Washington, and Wisconsin) that implemented the ACEs module in 2010, the rate of Alaska adults reporting witnessing abuse at home during their childhood was higher.^1^[[br]] [[br]] ---- {{class .SmallerFont 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. 10. U.S. Centers for Disease Control and Prevention (CDC). Adverse childhood experiences reported by adults - five states, 2009. MMWR 2010;59(49):1609-13. [https://www.cdc.gov/mmwr/pdf/wk/mm5949.pdf] Accessed October 31, 2017. }}

What Is Being Done?

Victims of domestic violence can contact the [http://www.andvsa.org/ Alaska Network on Domestic Violence & Sexual Assault (ANDVSA)] to be connected to help and resources in the area.^11^ Alaska has several programs like Abused Women's Aid in Crisis, Arctic Women in Crisis, Interior Alaska Center for Non-Violent Living, Women in Safe Homes, and Advocates for Victims of Violence. These programs provide many services, like a 24-hour crisis line, case management and advocacy, legal advocacy, emergency financial assistance, transitional housing, temporary housing for pets of domestic violence victims, education and outreach, and children's programs. 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):^12^ 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.^13^ 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 American Indian/Alaska Native women.^14^ 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.^15^[[br]] [[br]] ---- {{class .SmallerFont 11. Alaska Network of Domestic Violence & Sexual Assault. Need help? [http://www.andvsa.org/shelters-and-services/]. Accessed April 26, 2016. 12. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Adverse childhood experiences - overcoming ACEs in Alaska. [http://dhss.alaska.gov/abada/aceak/Documents/ACEsReportAlaska.pdf]. Published January 2015. Accessed April 26, 2016. 13. Alaska Native Tribal Health Consortium. Getting together - teen relationship safety card. [http://www.anthctoday.org/epicenter/healthyfamilies/teenCard_111014.pdf]. Accessed April 26, 2016. 14. Futures without Violence. We are worthy: American Indian/Alaska Native safety card. [https://www.futureswithoutviolence.org/we-are-worthy-alaska-safety-card/]. Accessed April 26, 2016. 15. Teens Acting Against Violence. Tundra Women's Coalition - Crisis Line - 1-800-478-7799 or 907-543-3456 website. [http://tundrapeace.org/programs/taav/]. Accessed April 26, 2016. }}

Evidence-based Practices

Recovering 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.^15^ ACEs consist of 10 domains organized into abuse (emotional abuse, physical abused, sexual abuse), household challenges (domestic violence, household substance abuse, mental illness in household, parental separation or divorce, criminal household member), and neglect (emotional neglect, physical neglect). 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.^6^ 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.^17^[[br]] [[br]] ---- {{class .SmallerFont 6. 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-k/Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016. 16. 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. 17. 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. }}
Page Content Updated On 10/31/2017, Published on 10/31/2017
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sat, 21 July 2018 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Tue, 31 Oct 2017 10:29:40 AKDT
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sat, 21 July 2018 14:43:46 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Tue, 31 Oct 2017 10:29:40 AKDT