The ACE Study, now in its 15th year, examines a range of early childhood traumatic stressors and their relationship to clinical, public health, and social problems throughout the lifespan (Felitti,1998; Anda, 2007; Brown, 2009). The key concept underlying the ACE Study is that childhood experiences such as abuse, neglect, witnessing domestic violence, or growing up with alcohol/substance abuse, mental illness, parental discord, or crime in the home can lead to social, emotional, and cognitive impairments, increased risk of unhealthy behaviors, violence, victimization or re-victimization, disease, disability, and premature mortality. These adverse experiences cause chronic stress that may play a key role in racial and ethnic health disparities. For instance, chronic stress affects health outcomes from pregnancy across the lifespan and even across generations (Briefing, 2012; RWJ, 2011). It is now known from breakthroughs in neurobiology that ACEs disrupt neurodevelopment and can have lasting effects on brain structure and function – the biologic pathways that likely explain the ACE Study findings (Anda & Brown, 2010; RWJ 2011). Children exposed to ACEs are vulnerable to poor health outcomes throughout their lives.
The Philadelphia ACE Task Force is co-chaired by: Sandra Bloom, MD, Associate Professor of Health Management and Policy and Co-Director of the Center for Non‐Violence and Social Justice at Drexel University; Joel Fein, MD, MPH, Professor of Pediatrics and Emergency Medicine at the University of Pennsylvania’s Perelman School of Medicine, Attending Physician in the Division of Emergency Medicine at The Children’s Hospital of Pennsylvania, and Director of the Philadelphia Collaborative Violence Prevention Center; and Lee Pachter, DO, Chief of General Pediatrics and Associate Chair for Community Pediatrics at St. Christopher’s Hospital for Children, and Professor of Pediatrics at Drexel University’s College of Medicine. Robert Anda, MD, MS, Co‐Principal Investigator of the ACE Study and Linda Chamberlain, PhD, MPH, the Inaugural Scattergood Foundation Scholar also provide senior mentorship. Emily Wilson, MPH, MS, CHES, Stoneleigh Foundation Fellow, is the Coordinator of the Philadelphia ACE Project.
In July 2012, ISF received a grant from the Robert Wood Johnson Foundation (RWJF) to support a pivotal year of planning and research to support the activities of The Philadelphia ACE Project. In addition to the RWJF, this effort is also being supported by the Stoneleigh Foundation, the Thomas Scattergood Foundation, the William Penn Foundation, The First Hospital Foundation and the CHG Charitable Trust.
- Investigate the who, what, where, when and how of ACEs across the country and their implications for interventions in pediatric settings;
- Develop an “Urban ACEs Questionnaire” that will better reflect the inner city, multicultural context of Philadelphia and include questions that specifically address some of the socio-economic determinants of health in Philadelphia;
- Conduct a population-based survey among Philadelphia residents to measure the scope and nature of ACEs and toxic stressors that exist in the city;
- Conduct qualitative studies regarding low-income urban youth and Latino families to identify and characterize the range of ACEs experienced and to describe the significance of ACEs on health status; and
- Hold a National Summit on ACEs in Philadelphia on May 14, 2013, hosted by ISF, to present the research findings and strategize the creation of a paradigm shift within pediatric health and mental health care, followed by a reception and forum presentation by national leaders in the field on “Childhood Restored: The Path from Adversity to Wellness.”
The next Philadelphia ACE Task Force Meeting date is to be determined and will be announced via email and on this web page. Thank you for checking in! If you have any questions, you may contact us at firstname.lastname@example.org.
“An Intervention to Reduce Toxic Stress by Enhancing Parenting: Practicing Safety Mindfulness Project for Mothers in Drug Treatment”
Diane J. Abatemarco, PhD, MSW, DIrector of Pediatric Population Health Research, Nemours/Jefferson Department of Pediatrics, presesented on work her with pediatricians, mothers and their babies in drug treatment at Family Center at Jefferson. Through an HHS funded grant Dr. Abatemarco is working to apply Practicing Safety and the practice of mindfulness to improve several outcomes for mothers, their babies and their pediatric providers. Very exciting and encouraging work! Mindfulness, which is practiced in a variety of mediation traditions, refers to being aware of what is happening in the present moment. The ability to be in the present moment can be achieved through conscious breathing. Mindfulness teaches people – patients and providers – to calm their minds and think more clearly. There is a growing body of research linking the practice of mindfulness to stress reduction and other key areas of health and well being. Presentation slides by Diane Abatemarco refer to the research behind this and other resources. The presentation sparked questions and answers on how this fits in with the multiple levels of community work and research and policy. Diane’s Powerpoint presentation slides can be viewed here.
The Urban ACE Study – Report and Publications Plan
Joel Fein, Roy Wade and Pete Cronholm, discussed some of the results from The Philadelphia Urban ACE Study. The study, which was funded by the Robert Wood Johnson Foundation and conducted by Public Health Management Corporation (PHMC) for the Institute for Safe Families and the ACE Task Force, collected data from Philadelphians regarding adversity that they faced. The questions developed for this survey expanded on the original questions from the ACE Study done in 1995. These new questions were the first extensive survey of this kind specifically in an urban setting. The data will be further analyzed by a team of ISF reasearchers . Following publication of the first papers in peer reviewed journals, ISF will entertain additional requests for the data and particular questions. There will also be a downloadable slideshow available for use. View the Philadelphia Urban ACE Report here.
Building our Local Momentum through Connections
Leslie Lieberman from Multiplying Connections, and Martha Davis discussed a plan to build an online community of practice for the Philadelphia area, that will support the sharing and collaboration around work on adversity and resilience.
The first step for the ACE Task Force members to participate in this is to join ACEs Connection, which is a national model of what we hope to do at a local level. Members of ACE Task Force are encouraged to go to acesconnection.com to request to join the site. There is no fee to join, but an approval process is required.
More information will be shared as the concept of a local community evolves. Funding is being pursued and will be needed to launch a local site that connects us. www.Acesconnection.com
Individual Updates and Announcements by Members
Congratulations to Roy Wade, a new Stoneleigh Foundation Fellow. During his fellowship he will capitalize on the recent Philadelphia momentum around ACEs to conceptualize and develop a childhood adversity assessment tool and promote its adoption amongst health and social service organizations.
Multiplying Connections and co-sponsors, Institute for Safe Families and School District of Philadelphia, are hosting Dr. Christopher Blodgett on Wednesday, October 23, 2013. He will be presenting “From ACEs to Action: Using the Science of Trauma and Resilience to Support Educational Success.” Spaces are limited and reservations can be made at email@example.com
Dr. Marilyn Benoit, who is the new Chief Medical Officer at Deveraux, shared that Devereaux has a website page, www.resilientfamilyblog.org that has great resources for families.
Janet F. Rosenzweig who is a Research Associate Prevent Child Abuse America mentioned a wonderful CDC&P new public health initiative to prevent child maltreatment , Essentials for Childhood coming out of the Centers for Disease Control and Prevention. The link is: http://www.cdc.gov/violenceprevention/childmaltreatment/essentials/
Next Meeting Date TBD
At the June Meeting of the Philadelphia ACE Task Force, Emily Wilson, Stoneleigh Emerging Leader Fellow presented to the group on her project, which encompassed review of national stakeholders in ACEs work. One of the key findings from national stakeholder feedback is that Philadelphia is ahead of the national curve in developing responses to ACEs. Task Force members shared their responses to the presentations from the National Summit on Adverse childhood experience. The Task Force discussed the need to expand ways to connect the institutions, organizations and individuals who are working in the Philadelphia area in order to continue to advance the work.
Dan Taylor’s article on trauma in The Philadelphia Inquirer was shared.
A panel of local experts presented on the following: “What Can Be Done About ACEs? Lessons and Case Studies from the Field” The following infographic was reviewed: http://vetoviolence.cdc.gov/childmaltreatment/phl/resource_center_infographic.html
"Integrating Behavioral Health in Primary Care Settings: Dilemmas and Approaches to Primary and Secondary Intervention and Prevention" Suzanne Daub, LCSW, Senior Integrated Health Consultant, The National Council for Behavioral Health, who discussed the integration of behavioral health into primary care and described how integration is on a continuum: Referral Relationship, Co-location, and more fully integrated.
"Partnering with Parents: Positive Parenting as a Universal Primary Prevention Strategy" For Maria McColgan, M.D., Director, Child Protection Program, St. Christopher's Hospital for Children: Martha Davis and Marcy Witherspoon (ISF) spoke about the Partnering with Parent/Family Safe Zone program that Institute for Safe Families (ISF) coordinated with the hospital. This work is an answer to “What to do about ACES in pediatrics” and is a multilevel intervention focused on universal positive parenting and hospital-wide One Kind Word training and on-site parenting support in the clinics
"Integrating Behavioral Health in a Primary Care Setting: A Case Study" Stacy Carpenter, PsyD, Behavioral Health Consultant, 11th Street Health Center, described the work at 11th Street Health Center as a holistic approach to addressing ACES. In theearly days, an outpatient therapist came in once per week as an experiment to see if this service was beneficial to patients. With grant funding, the Center was able to analyze the results as successful and now conducts a program that is utilized at every well visit.
"Using Evidence-Based Trauma-Focused Treatment for Families Who Have ACEs" Julie Campbell, LCSW, Coordinator of Trauma-Focused Projects, Children’s Crisis Treatment Center (CCTC) presented the work that CCTC is using with evidence-based trauma-focused treatment. Trauma care is in its 24th year at CCTC. After ACEs have occurred, knowing how positive coping skills can help going forward. There is a focus on helping families understand what may be “coming down the road” as a result of being exposed to high levels of trauma/ACES. Many of the children that CCTC works with, have adults who have had multiple ACEs themselves.
"A Plan for Philadelphia: How Community Behavioral Health is Becoming Trauma Informed" Kamilah Jackson, MD, MPH, Associate Medical Director for Child and Adolescent & Services/Physician Advisor, Community Behavioral Health, described the development of the City Behavioral Health Department toward becoming more trauma informed – this is one of the core values for the Department. They are working to have a more comprehensive public health approach. Their work addresses and decreases stigma in communities, for example, through the mural arts program they are working on children’s trauma and resiliency.
Philadelphia ACE Task Force Research Updates
Philadelphia Urban ACEs Survey: Mary Harkins Schwarz updated the Task Force about Philadelphia Health Management Corporation’s work on the ACEs Questionnaire and Survey that was conducted in the winter;
Pediatricians’ knowledge and use of the ACEs questions in practice. A subgroup met to design a survey for data collection with Pennsylvania pediatricians.
ACE Project Update – October 2012
Since formally beginning her position in July 2012, Emily Wilson, ISF’s Stoneleigh Emerging Leader Fellow and Coordinator of the Philadelphia ACE Project, has been heavily engaged in researching ACE and trauma-informed stakeholders and performing local, regional, and national outreach within the ACE community.
Emily has met with and continues to reach out to local practitioners and health professionals within Philadelphia who are involved with ACE research, practice, and advocacy in pediatric and other settings, as well as thought leaders, professionals, and practitioners across the U.S. Emily is mapping ACE stakeholders and programs, investigating emerging best practices, and collecting strategies for educating, leveraging, and mobilizing policy and decision makers on ACEs.
In-person and phone-based meetings have formed the foundation for the development of a rich bank of information. Some common findings include:
- ACE-related activities such as education and training, advocacy, research, and early implementation of interventions are happening in pockets across many states and municipalities (see map).
- Activities are typically being launched by small groups of ACE-informed individuals and champions in each state who have received training on the ACE Study directly from Dr.’s Anda and Felitti.
- In many cases, these small groups have grown into larger coordinating bodies (Steering Committees, Think Tanks, etc.) that include a broad base of professionals and advocates across disciplines.
- Almost 100% of stakeholders who have engaged in state level policy change cited the importance of building support across a robust set of domains, including health, human services, education, domestic violence, law enforcement, and child welfare.
- Although ACE Community professionals are highly committed and invested in building an ACE-informed infrastructure in their communities, they often express a feeling of “operating in isolation” and also express a desire and interest in a national ACE-related center of excellence or coordinating body.
Emily has also contributed to the research and development of “urban ACE” questions that will be included in the population-based survey ISF is conducting among Philadelphia residents to measure the scope and nature of ACEs and toxic stressors that exist in the city.
Last month, ISF convened the second meeting of the Philadelphia Adverse Childhood Experience (ACE) Task Force for presentations and a rich discussion on current ACE-related research being conducted by a range of investigators and agencies throughout the City. Members of the Task Force met at ISF’s headquarters in East Falls on October 10th and were led through introductions by ISF Executive Director Martha Davis and Center for Non-Violence & Social Justice Co-Director and Task Force Co-Chair Dr. Sandy Bloom, who facilitated a Community Meeting-style ice breaker activity to kick off the gathering. Since its inception and initial meeting earlier in 2012, the Philadelphia ACE Task Force has continued to grow in size and scope and is now comprised of a wide-reaching and constantly emerging set of community partners and agencies, with representation from:
- Nine local universities and hospitals, including several innovative research and care centers of excellence
- Four Philadelphia and Pennsylvania-based philanthropic organizations and foundations
- Four local, community-based, non-profit behavioral health and human service provider agencies
- Three training and consultation organizations, including local and national agencies
- Two government health agencies from within the City of Philadelphia
- Two regional affiliates of national child health advocacy groups
- One Philadelphia-based federally-qualified health center (FQHC)
- One local, independent research organization
- One large, regional public media outlet
Members in attendance at the October meeting were invited to hear presentations and engage in question and answer sessions with local practitioners currently engaged in ACE-related research, including Dr. Patty Gerrity, Professor and Associate Dean for Community Programs and Dr. Roberta Waite, Associate Professor and Assistant Dean of Academic Integration and Evaluation of Community Programs, both at the 11th Street Family Health Clinic and the Drexel College of Nursing. Dr.’s Gerrity and Waite reported on their current ACE-related programming that is being provided at the Clinic, and Dr. Waite presented on her findings from a 2010 study, in which she replicated the design of the original ACE Study among her patients at the 11th Street Health Clinic.
The group also heard from Dr. Roy Wade, Robert Wood Johnson Clinical Scholar who is now in the data analysis phase of a qualitative study among young adults in Philadelphia on their experiences and perceptions of early childhood trauma, and Dr. Lee Pachter, Chief of General Pediatrics at St. Christopher’s Hospital for Children, who is in the early stages of conducting a study on traumatic experiences including marginalization and discrimination among Latino families in Philadelphia. Other presentations included an update from Mary Harkins-Schwarz, Senior Research Associate at Philadelphia Health Management Corporation (PHMC) on the current Urban ACE Study being led by ISF in conjunction with PHMC among adult Philadelphians, and a project update by Emily Wilson, Stoneleigh Foundation Emerging Leader Fellow and Philadelphia ACE Project Coordinator on her mapping of ACE-related programs, policy developments, research, and advocacy across the United States.
The meeting closed with the official save the date and announcement of the 2013 National Summit on ACEs which will be held on May 13, 2014, hosted by ISF, and co-sponsored by the American Academy of Pediatrics, the Academy on Violence and Abuse, and Futures Without Violence.
To find out more about ISF or The Philadelphia ACE Task Force, please call, email, or check us out online, and be sure to follow us on Twitter:
Leslie Lieberman, MSW
Associate Director of Training
Director, Multiplying Connections
Health Federation of Philadelphia
1211 Chestnut Street, Suite 700
Philadelphia, PA 19107
215-567-8001 ext 3031
Co-leaders of the Philadelphia ACE Task Force
Sandra Bloom, MD
Associate Professor, Health Management and Policy
Drexel University School of Public Health
Co-Director, Center for Nonviolence and Social Justice, Drexel University
Joel Fein, MD, MPH
Professor, Pediatrics and Emergency Medicine
The Perelman School of Medicine at the University of Pennsylvania
Attending Physician, Division of Emergency Medicine
The Children's Hospital of Philadelphia
Director, The Philadelphia Collaborative Violence Prevention Center
Lee Pachter, DO
Chief, Section of General Pediatrics, Associate Chair for Community Pediatrics
St. Christopher's Hospital for Children
Professor, Pediatrics, Drexel University College of Medicine
Advisors to the Philadelphia ACE Task Force
Robert Anda, MD, MS
Co-Principal Investigator, ACE Study
Linda Chamberlain, PhD, MPH
Scattergood Foundation Scholar
Founding Director, Alaska Family Violence Prevention Fund
Staff of the Philadelphia ACE Task Force
Leslie Lieberman, MSW
Director - Multiplying Connections, The Health Federation of Philadelphia
Operations Manager - The Philadelphila ACE Project, Health Federation of Philadelphia
Philadelphia ACE Task Force Members
Steven Berkowitz, MD
Associate Professor of Clinical Psychiatry, University of Pennsylvania
Director, Penn Center for Youth and Family Trauma Response and Recovery
Director, Lutheran Settlement House Bi-Lingual Domestic Violence Program
Ronnie Bloom, Esq.
Senior Consultant, The William Penn Foundation
Julie Campbell, LCSW
Coordinator of Trauma-Focused Projects, Children’s Crisis Treatment Center
Cindy Christian, MD
The Children's Hospital of Philadelphia
Director, Safe Place: Center for Child Protection and Health
Endowed Chair in Prevention of Child Abuse and Neglect
Esther Chung, MD, MPH, FAAP
Professor of Pediatrics
Jefferson Medical College and Nemours
Peter Cronholm, MD, MSCE
Assistant Professor, Department of Family Medicine and Community Health
University of PA
Mario Cruz, MD
Department of General Pediatrics, St. Christopher's Hospital for Children
Suzanne Daub, MSW, LCSW
Integration Consultant, The National Council for Community Behavioral Healthcare
Cynthia DeLago, MD, MPH
Director, Pediatric and Adolescent Ambulatory Center, Albert Einstein Medical Center
Anat Feingold, MD
Division Head, Pediatric Infectious Disease, Cooper University Hospital
Patricia Gerrity, RN, PhD, FAAN
Director, Eleventh Street Family Health Services Center
Carole Haas Gravagno
President, CHG Charitable Trust
Mary Harkins-Schwarz, MPH
Senior Research Associate
Public Health Management Corporation
Kamilah Jackson, MD, MPH
Associate Medical Director for Child and Adolescent Services,
Community Behavioral Health
Lynne Kotranski, PhD
Managing Director, Research and Evaluation
Public Health Management Corporation
Sara (Sally) Kuykendall, PhD, MPH
Chair and Associate Professor in Health Services, Saint Joseph’s University
Leslie Lieberman, MSW
Director, Multiplying Connections, The Health Federation of Philadelphia
Maria D. McColgan, MD, MEd
Assistant Professor of Pediatrics & Emergency Medicine
St. Christopher's Hospital for Children
Director, Child Protection Program, St. Christopher's Hospital for Children
Diana Milner, MCP
Program Officer, Stoneleigh Foundation
Rachel Myers, MS
PhD Student, Temple University, Department of Public Health
Research Coordinator, Center for Injury Research and Prevention, CHOP
Manager, Healthy Parenting Initiative, United Way of Southeastern Pennsylvania
Teresa Olsen, MEd
Program Director, SCAN, PA Chapter, American Academy of Pediatrics
President, The Thomas Scattergood Behavioral Health Foundation
Susan Robbins, MD
Philadelphia Department of Public Health
Janet F. Rosenzweig MS, PhD, MPA
National Consultant, Sexual Abuse Prevention Programs Prevent Child Abuse America
Stephen Sandelich, MD
St. Christopher’s Hospital for Children
Executive Director, Staunton Farm Foundation
Behavioral Health Reporter, WHYY
Philip V. Scribano, DO, MSCE
Medical Director, Safe Place: Center for Child Protection and Health
Program Director, Child Abuse Pediatrics Fellowship
The Children's Hospital of Philadelphia
Tirzah R. Spencer, PhD, MPH
Consultant, Biobehavioral Health Professional on
Integrated Community Health Initiatives
Program Director, Prevent Child Abuse PA
Tom Storey, MD, MPH
Director, Ambulatory Health Services
Philadelphia Department of Public Health
Daniel Taylor, DO, FAAP
Assistant Professor, Drexel University College of Medicine
Director Community Pediatrics and Child Advocacy
Roy Wade, MD, PhD, MPH
Robert Wood Johnson Clinical Scholar
The University of PA
Diane Wagenhals, MEd
Institute for Family Professionals
Roberta Waite, Ed D, APRN, CNS-BC, FAAN
Associate Professor of Nursing and Assistant Dean of Faculty Integration and Evaluation of Community Programs
The Josiah Macy Jr. Foundation, Macy Faculty Scholar
Drexel University, College of Nursing and Health Professions
Executive Director, Stoneleigh Foundation
Marcy Witherspoon, MSW, LSW
Special Consultant, Institute for Safe Families
Director, PA Chapter, American Academy of Pediatrics