Adverse Childhood Experiences (ACEs) and Resilience

Adverse Childhood Experiences impact health over the life course and have negative effects on social, behavioral, mental, and physical health. ACEs are defined as stressful or traumatic experiences occurring before the age of 18, such as abuse, neglect, substance use, divorce, and/or domestic violence. ACEs have been linked to premature death with those experiencing 6 or more ACEs dying 20 years earlier than those without any ACEs.¹

Resilience is the positive adaptation to adversity and reduces or eliminates the long-term negative effects associated with experiencing adversity in childhood.

Measure: Adverse Childhood Experiences

We defined ACEs responses in two ways:

1. when the respondent reported 1 or more ACEs and
2. when the respondent reported 4 or more ACEs

Findings from the 2019 Santa Barbara County CHNA

Though not statistically significant, females more than males and non-Hispanic Whites more than Hispanics report at least 1 ACE. Education appears most related to ACEs in that those with college education report significantly less ACEs than those with a high school level of education. Most impacted demographic subgroups include non-Hispanic Whites, those age 45-64 and those with a high-school education (see figure below).

Additional adverse childhood experiences (ACEs) findings from the 2019 Santa Barbara County CHNA can be found in the ACEs Health Indicator Profile. Follow this link to learn more about the methods for health indicator profile analysis.

Figure 1. 2019 Percentage of Adults Reporting 1 or More and 4 or More Adverse Childhood Experiences by Demographic Group

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Measure: Resilience

Resilience was measured using the Connor-Davidson Resilience Scale (CD-RISC 2), which is comprised of two items:

1. I am able to adapt when changes occur and
2. I tend to bounce back after illness, injury, or other hardships. The response options for each item are not true at all, rarely true, sometimes true, often true, or true nearly all the time.

A resilience score is calculated by summing the two items, and low resilience is defined as those that scored in the lowest 25 percentile.

Findings from the 2019 Santa Barbara County CHNA

Low resilience is most prevalent amongst females, those without a high school diploma or GED, Hispanics, and those that reside in households that report an income of less than $35,000 per year. However, the only statistically significant observed disparity in low resilience is between the highest and lowest income brackets.

Findings from the 2019 Santa Barbara County Listening Tour

Cottage Health and its partners heard from a wide array of leaders and community members through a Listening Tour focused on behavioral health. A full Listening Tour report related to adverse childhood experiences (ACEs) can be found in the ACEs Health Indicator Profile.

Inherent in the Listening Tour discussions about mental health and substance use patterns are stories of trauma. Mental health service providers attested to the importance of measuring Adverse Childhood Experiences as a baseline for providing trauma-informed care. Listening Tour participants identified vulnerable populations experiencing trauma and adversity: foster youth living in unstable homes and Latinx community members who experienced the traumatic process of immigration and who continue to experience fear while living in a xenophobic social context.

Listening Tour participants call for trauma-informed care to be provided by healthcare professionals. Those in the behavioral healthcare community recommend the skills-based community resilience model as a good path to follow. In addition, family advocates and peer advocates are seen as critical liaisons to help care-seekers navigate the healthcare system.

^{1 Brown DW, Anda RF, Tiemeier H, et al. Adverse childhood experiences and the risk of premature mortality. Am J Prev Med. 2009;37(5):389-396. doi:10.1016/j.amepre.2009.06.021}