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State of Alaska

Health Indicator Report of Adverse Childhood Experiences: Incarcerated Household Member

More than 2.7 million children in the U.S. have an incarcerated parent, and approximately 10 million children have experienced parental incarceration at some point in their lives.^2^ Living with someone who served time or was sentenced to serve time in a prison, jail, or other correctional facility can have an impact on a child's mental health, social behavior, and educational prospects. The emotional trauma that may occur and the practical difficulties of a disrupted family life can be compounded by the social stigma that children may face as a result of having a parent in prison or jail. Children who have an incarcerated parent may experience financial hardships that result from the loss of that parent's income. Incarcerated household members are unable to work on adult-child relationship skills that may be necessary for reunification, and separation interferes with the ability of the household member and child to form or maintain a strong attachment. Children may have experienced trauma related to the person's arrest or experiences leading up to it.^3^ Separation due to a parent's incarceration can be as painful as other forms of parental loss and can be even more complicated because of the stigma, ambiguity, and lack of social support and compassion that accompanies it. The impacts of overwhelming stress on a child's brain continue into adulthood and can have generational impacts. As Alaska children experience a household member being incarcerated, they may find negative ways to cope with their damaged stress responses. As adults who start families of their own, these behaviors can become Adverse Childhood Experiences (ACEs) for another generation.^4^ In fact, children of incarcerated parents are more likely to drop out of school, engage in delinquency, and subsequently be incarcerated themselves.^5^ 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.^6^[[br]] [[br]] ---- {{class .SmallerFont See "Resources and References" section for references. }}

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 on an incarcerated household member was asked in 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 "Yes" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "Did you live with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility?"

Numerator

Weighted number of adults (18+) who responded "Yes" on the BRFSS to the question: "Did you live with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility?"

Denominator

Weighted number of adults (18+) who responded to the incarcerated household member question, 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.

How Are We Doing?

In 2013-2015 combined, 11.3% of Alaska adults reported having experienced living with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility. Alaska Native adults reported significantly higher prevalence of 21.4%. Married adults reported significantly lower prevalence at 7.7% compared to divorced/separated adults (13.7%), never married adults (17.2%), and adults living with a partner (19.5%). Those adults who were college graduates reported a prevalence of 5.5%, significantly lower than those who had less than a high school education at 23.1%. There was also a significant difference among adults with different incomes - those making less than $15,000 reported a prevalence of 19.4%, while those making more than $75,000 reported 7.3% having experienced an incarcerated household member. Overall, there were few differences in rates among geographic areas, but the prevalence in Northern Alaska was the highest at 20.4%. Rates of an incarceration of a household member 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 by demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status). Crosstabulations were also conducted for three-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 incarceration of a household member 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 five states (i.e., Arkansas, Louisiana, Tennessee, New Mexico, and Washington) that used the BRFSS ACEs module. When compared to the five states, Alaska reported the highest rate of adults reporting that they had lived with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility.^1^ Compared to data from adults from the 10 states (i.e., Hawaii, Maine, Nebraska, Nevada, Ohio, Pennsylvania, Utah, Vermont, Washington, and Wisconsin) that implemented the ACEs module in 2010, Alaska had higher rates of adults reporting they have lived with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility.^7^[[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. 7. 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?

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):^4^ The [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] initiative developed strategies by content experts to increase youth with family and/or social support. Public health partners around the state are aligning work around these approaches adapted by Alaska's unique needs. Alaska strategies include: promoting connectedness and healthy youth-adult relationships in schools, and providing services to support all young people in developing a sense of competence, usefulness, belonging, and empowerment.^8^ The [http://www.bbbsak.org/site/c.8oJELSPuFeJYG/b.8767999/k.F189/Home_Page.htm Big Brothers Big Sisters] program matches adult volunteers with children of prisoners. The goal is to support healthy development through positive adult contact, reducing risk factors for negative behavior, and enhancing protective factors for positive behavior. The increased level of support allows youths to view themselves more positively and to engage in more constructive behavior.^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]] [[br]] ---- {{class .SmallerFont 4. 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. 8. Alaska Department of Health and Social Services. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed April 26, 2016. 9. Alaska Native Tribal Health Consortium. Getting together - teen relationship safety card. [http://www.anthctoday.org/epicenter/healthyfamilies/teenCard_111014.pdf]. Accessed April 26, 2016. 10. 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

The [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] initiative developed strategies by content experts to increase youth with family and/or social supports. Their strategies were based on evidence based practices including: School climate is the quality and character of the experiences of students, parents, educators, and school personnel. School climate reflects the values and community norms of the school community. A positive school climate promotes childhood and youth development and fosters connectedness. School connectedness is "the belief by students that adults and peers in the school care about their learning as well as about them as individuals" (CDC, 2009). Relationships are essential to adolescent health. Connections with parents, peers, and other adults/mentors support and influence youth development. Research shows that healthy youth development strategies that provide all youth with the supports needed to become successful and competent adults are promising approaches for preventing or reducing a wide range of adolescent health-risk behaviors. Positive Youth Development (PYD) programs promote mental and emotional wellbeing by providing the supports and opportunities youth need to successfully transition to adulthood. PYD programs build on young persons' strengths and talents to help them gain the knowledge and skills they need to become healthy and productive adults. PYD programs are most effective when implemented by entire communities with meaningful youth participation.^8^ 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.^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.^5^ The 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^
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 Sun, 15 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 10:19:59 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 Sun, 15 July 2018 13:22:23 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 10:19:59 AKDT