Opinion | Addressing adverse childhood experiences vital to Michigan’s future

Rick Murdock is the grant consultant for the Michigan ACE Initiative

As Michigan’s newly elected governor and legislators prepare to take office,   one of the largest crises facing our state is going largely unnoticed: adverse childhood experiences (ACEs).

A growing body of science and research show that young people who experience abuse, neglect and household dysfunction, collectively known as ACEs, without intervention, have a very high likelihood of facing risky health and social behaviors, chronic health conditions, low life potential and even early death.

As a result, society is paying billions of dollars a year to combat conditions such as smoking, diabetes, alcoholism and drug abuse, and is incarcerating hundreds of thousands of individuals at a very high cost, all due to ACEs. Imagine the savings if we had the will to intervene early and effectively to reduce the impact of ACEs on individuals.

For the last two years, I’ve been part of a diverse group of health care and child advocates who have been spreading the word around Michigan about the need to identify young people who are suffering from ACEs. The Michigan ACE initiative, created by the Michigan Association of Health Plans (MAHP) and the MAHP Foundation, has trained more than 100 educators, public health experts, nurses, doctors, police officers and more across the state in how to identify children facing a high ACE score and how to properly intervene.

The science of ACEs is clear. When facing major stress or danger, the body releases a flood of hormones, such as cortisol, that rush through the brain. The hormones help with the “fight or flight” response that was vital to human survival thousands of years ago, giving people extra strength, speed and the ability to react quickly.

But the human brain is only made to be under stress for about 20 minutes at a time.  Continuous stress and trauma is known as toxic stress, and it wreaks havoc on a developing brain. A young person who fears an abusive parent, who is subject to sexual abuse, or who hears gunshots at night, without getting positive reinforcement, often has their brain changed in a way that leads to poor decisions and self-medication that has heavy costs to the individual, the family and society.

However, this can be averted. Smart investment in services and outreach to children early in life can change this pattern and help parents break the cycle that leads to these outcomes. It starts with a recognition of ACEs. From that recognition must come public policies that can intervene, saving billions for society and giving individuals opportunities they simply will not be able to take advantage of otherwise.

A Citizens Research Council of Michigan report shows that we spend more than $70 billion on health in Michigan without measurably improving health outcomes. (Editor’s note: Citizens Research Council says the above statement is an oversimplification of the findings in its report) More Michiganders smoke and/or are obese than the national average. Michigan has a higher rate of infant mortality and its residents have a shorter life expectancy at birth than the U.S. average. ACEs are an important factor.

Michigan needs greater investment in public health. That investment means greater philosophical buy in, starting in the governor’s office. The Michigan ACE Initiative has taken a strong position on public policy to reduce ACEs, one of the key recommendations being to shore up the safety net. This is due to the recognition that public spending on such areas as safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services and environments free of life-threatening toxins all reduce ACEs. By taking the steps to reduce ACEs, we will substantially reduce future payments in health care, corrections and more.

ACEs are the greatest public health crisis of our time. To continue to support the status quo will condemn future generations to poor health outcomes and higher health care costs. Smart investment in public health aimed at breaking the ACE cycle can be a huge investment in our state’s future.

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Shirley Shane
Wed, 11/14/2018 - 8:43am

This is right on the mark. We need to address these problems at their roots, not just throw a band-aid on top when they've festered. Let's go one step further and come to grips with the problem of how to help people not be perpetrators in the first place. Peaceful society thrives on itself, not on dissension and bad actions.

Wed, 11/14/2018 - 9:45am

This investment would be so smart! The problem is that politicians will be reluctant to invest a large sum in a policy whose payoff is so distant. But we make equally long-term investments every day when we pay mortgages, college-saving plans, and IRAs. Let's do for our state what we so easily do for ourselves - we will be the beneficiaries.

John Budd
Wed, 11/14/2018 - 10:22am

Does this study meet proper reasearch criteria, “A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded.” Before intervention the next logical step would be to determine relationships to social, economic, race, education, and other significant factors of the distribution of ACE. If you have this information please share. The intervention seems to be in the wrong place.

Amy Peterson
Thu, 11/15/2018 - 7:05am

This has already been extensively studied over the last several years are many studies have controlled for the variables you mentioned and the results are consistent. We're now in the intervention stage as much research has been done

Wed, 11/14/2018 - 11:21am

Our current healthcare system is built on a “sickness” model. The finance people in healthcare know it is more profitable to keep people sick than work on prevention. I know because I worked in the system as a nurse.
Michigan once again ranks at the bottom when it comes to prevention. The sickness “system” in MI needs a lot less money. This includes insurers, and health care providers, and then fund some creative, collaborative initiatives to emerge which will promote health.

This bloated, monstrous system is all about competition, not serving the people.

I now serve those people really interested in health.

Wed, 11/14/2018 - 12:09pm

Plenty of research since the landmark Fellitti publication to which John Budd refers confirms the influence of ACEs on future health outcomes. I would like to see research extend that to trauma experienced by adults. Most important, we need to find out how best to not just prevent but also treat people who have these experiences.

Erwin Haas
Wed, 11/14/2018 - 8:22pm

Breathtaking. Comparable in its scientific credes to Christine Ford's amygdala bandied about to add heft to her jibber.
There are, I suppose scattered, poorly done studies on stress among kids, or adults for that matter, that show elevated steroids, but, I'd intuit, that these are taken from screwed up people ab initio, so pathologic before we even begin to test.
The proposer of us spending vast sums on his big idea has to prove that there is such a causal chain, that stress produces mental damage on kids via some sort of steroid hormonal flux. He has to support its existence, via a testable and falsifiable theory, and then do the research to back it up, not I to disprove it.
I kind of admire the entrepreneurial idea of inventing fake catastrophes to attract vast sums of pelf.
I, as a taxpayer, and the kids/parents/communities whose civil liberties will be trampled by this unsupported fantasy should not have been used or promoted in Bridgemi. It's fake news.

john chastain
Sun, 11/18/2018 - 8:07am

Erwin, not sure where your going with this comment. Are you saying that childhood sexual abuse and neglect aren’t real? Or is the chronic stress that results is exaggerated. Perhaps as one person I know when referring to a sexually abused child asked “isn’t she over that yet” you simply don’t know what your talking about.

Anne O'Rourke-Bean
Thu, 11/15/2018 - 3:34pm

Dr. Nadine Burke-Harris' book the DEEPEST WELL discuss her "discover" of ACEs in her medical practice in CA and she implementated change in care. Its an easy read and exteremly informative.

Charlie Green
Wed, 11/21/2018 - 8:58pm

I am a volunteer assistant for the Dale Carnegie course that every ovid-elsie freshman takes as part of the school day curriculum. The course is about building social emotional skills, building confidence, learning ways to deal with stress, people skills, leading others etc. My 240 hours with kids so far has opened my eyes to the pervasiveness of ACEs. I have witnessed amazing transformations as these kids apply new skills to their relationships with family, peers, and school staff. The kids are realizing the have the power to influence relationships, and respond instead of just reacting to the stress of ACEs. The kids in each class form strong bonds and understanding across the boundries of typical school cliques. While we are not addressing the root causes, I believe this has great potential to mitigate the effects, and in the long term they will be more effective parents and positive productive citizens. Ovid Elsie is the only public school in the country to offer this time tested program.