Workplace Impacts of Adverse Childhood Experiences (ACEs)
Workplace impacts of Adverse Childhood Experiences (ACEs) is an important concept for businesses to understand.
Why?
Let me answer this question by first explaining a bit about…
Adverse Childhood Experiences and the CDC-Kaiser ACE Study
Adverse childhood experiences are traumatic or stressful events occurring in a person’s life before age 18. They were identified in the CDC-Kaiser ACE Study.
The original ACE Study was conducted at Kaiser Permanente from 1995 to 1997 with two waves of data collection. Over 17,000 Kaiser Members were asked to complete confidential surveys regarding their childhood experiences and current health status and behaviors.
According to the article explaining the ACE Study findings appearing in the American Journal of Preventative Medicine, May 1998;14(4):245-58 covering the first wave:
Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease.
More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. The number of categories of adverse childhood exposures showed a graded relationship (meaning the more ACEs, the greater the negative health impacts) to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.
According to the CDC’s About the CDC-Kaiser ACE Study website > Major Findings:
The Study showed that as the number of ACEs increases so does the risk for the following*:
- Alcoholism and alcohol abuse
- Chronic obstructive pulmonary disease
- Depression
- Fetal death
- Health-related quality of life
- Illicit drug use
- Ischemic heart disease
- Liver disease
- Poor work performance
- Financial stress
- Risk for intimate partner violence
- Multiple sexual partners
- Sexually transmitted diseases
- Smoking
- Suicide attempts
- Unintended pregnancies
- Early initiation of smoking
- Early initiation of sexual activity
- Adolescent pregnancy
- Risk for sexual violence
- Poor academic achievement
*This list is not exhaustive. For more outcomes see selected journal publications.
This video, “ACEs Primer,” covers both waves of this study, which ultimately had a study population of 17,000 of which almost 2/3 had at least 1 ACE and 87% of those participants had 2 or more.
Experiencing ACEs in the absence of protective factors that foster resilience can result in a child developing toxic stress. This can continue well into adulthood unless the underlying causes are treated or mitigated because of the way toxic stress changes a child’s brain. This is explained in this post, The Developing Brain and Adverse Childhood Experiences.
And it is toxic stress that causes the health and quality of life impacts listed above, which results in…
Workplace Impacts of Adverse Childhood Experiences
Experiencing ACEs Can Impair Worker Performance, One of the Workplace Impacts of Adverse Childhood Experiences Image Source: ACEs Too High > Got Your ACEs Score, https://acestoohigh.files.wordpress.com/2011/11/aceworker.png (accessed 6.4.19).
As for the workplace impacts — experiencing ACEs impairs worker performance according to findings reported in “Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance,” Anda, R.F., et al., The Permanent Journal, 8(1), 30-38, showed:
Chronic back pain in the workforce is estimated to cost US businesses as much as $28 billion per year;5 depression and its work-related outcomes—absenteeism, reduced productivity, and medical expenses—are estimated to cost as much as $44 billion per year;6 and chemical dependency is estimated to cost $246 billion per year.7 These massive losses occur despite existence of workplace safety programs and the most expensive system of medical care in the world.8
To be clear – the above is not a direct connection to ACEs-related toxic stress, however many of the above are manifestations of ACEs-related kinds of toxic stress. The following illustrates how this connection works:
Image Source: Anda, Robert F et al. “Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance.” The Permanente journal vol. 8,1 (2004): 30-8, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690705/ (accessed 6.4.19).
Additionally, according to “Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance,” Anda, R.F., et al., The Permanent Journal, 8(1), 30-38,
Our findings suggest that employers and HMOs have both the need and the opportunity to work together against the long-term effects of childhood abuse and household dysfunction. Exposure to such adverse circumstances is likely to lead to massive financial expenditures for health care as well as to economic losses attributable to poor work performance. Adverse childhood experiences are a source of many problems—somatic manifestations of health and social problems—treated by occupational medicine specialists. The traditional search for organic causes of illness and injury among workers is expensive for employers, who must pay higher insurance premiums for their workers. In addition, this traditional process is expensive for health care organizations, because much of such medical care is ineffective or inefficient: diagnostic procedures are used without sufficient understanding of the common psychosocial origins of symptoms, multiple office visits and specialty referrals are used in repeated efforts to resolve the same problem, and drugs are prescribed to little or no effect. Most important, workers suffer when their health problems and health-related social problems remain unresolved. If even a small fraction of the economic and human resources currently spent on these conventional approaches was used to identify and address the root origins of these problems in the workforce, we could reasonably expect to find more effective ways to improve worker health, well-being, and performance [emphasis added].
What Employers Can Do to Raise Employee Awareness of ACEs
First of all – it is to understand this is not about encouraging or even suggesting employers identify or track an employee’s ACE score. Rather it is about helping employers understand this connection and the importance of sharing this information to help their employees understand this in the event any of it is applicable to them. Equally important will be the availability of relevant, evidence-based EAP programs to which employees may be directed for further information and help resources.
Raising awareness about Adverse Childhood Experiences (ACEs) and the ACEs Study in the workplace offers companies and agencies an incredible three-fold opportunity to:
- help employees understand the root origins of their physical and emotional health concerns (ACEs) and offer EAP programs that employees may select for further information and help,
- reduce the ACEs-related impacts on worker performance and thus improve the workplace environment for all concerned, as well as the company/agency’s bottom line, and
- help a company or agency become trauma informed — meaning to understand how trauma (ACEs, childhood trauma) affects a person, an effect that can be reversed once understood and treated.
To begin the conversation in your workplace, I suggest employers check out this article, Got Your ACE Score? It contains information on the ACE Study, the ACE Questionnaire, and links to key information.
The big take-away for employers to become ACEs informed and then to raise employee awareness. Talk about ACEs. Talk about the health impacts of ACEs and share health support opportunities. The same way companies offer information about other health concerns along with health support opportunities for those concerns, like nutritionists, trainers, coaches, and the like.
To learn how businesses around the country are incorporating the ACEs science in their workplaces, check out “Business leaders in the ACEs science and resilience movement: A different kind of bottom line.”
[Note: this same article topic and some if it’s content first appeared on my site, SHD Prevention.com, on March 2017.]
Lisa Frederiksen
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Creating trauma informed and ACEs aware human resources practices benefits everyone. It is not necessary to identify any particular individual as relates to their ACEs score to create a viable and positive workplace environment for everyone.
The mantra should not be what’s wrong with this employee. It should be what an be done to help this employee, any employee.
A model for this is ADA awareness. By creating an environment that is ADA aware you create an environment that is friendlier for everyone.
Thank you for your comment and excellent points, Dennis. I hadn’t thought of using the ADA awareness model – sounds like a great idea. I’ll look into it for further understanding.