Legislature(2023 - 2024)GRUENBERG 120
02/20/2023 01:30 PM House JUDICIARY
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| Audio | Topic |
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| Start | |
| Presentation(s): Adverse Childhood Experiences | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
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ALASKA STATE LEGISLATURE
HOUSE JUDICIARY STANDING COMMITTEE
February 20, 2023
1:30 p.m.
MEMBERS PRESENT
Representative Sarah Vance, Chair
Representative Ben Carpenter
Representative Craig Johnson
Representative David Eastman
Representative Andrew Gray
Representative Cliff Groh
MEMBERS ABSENT
Representative Jamie Allard, Vice Chair
COMMITTEE CALENDAR
PRESENTATION(S): ADVERSE CHILDHOOD EXPERIENCES
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
TREVOR STORRS, President and CEO
Alaska Children's Trust
Juneau, Alaska
POSITION STATEMENT: Co-presented a PowerPoint, titled "HJUD
ACEs," during the presentation on Adverse Childhood Experiences.
JARED PARRISH, PhD, Senior MCH Epidemiologist
Department of Health
Juneau, Alaska
POSITION STATEMENT: Co-presented a PowerPoint, titled "HJUD
ACEs," during the presentation on Adverse Childhood Experiences.
LINDA CHAMBERLAIN, PhD, Epidemiologist/Consultant
Homer, Alaska
POSITION STATEMENT: Co-presented a PowerPoint, titled "HJUD
ACEs," during the presentation on Adverse Childhood Experiences.
ACTION NARRATIVE
1:30:10 PM
CHAIR SARAH VANCE called the House Judiciary Standing Committee
meeting to order at 1:30 p.m. Representatives Vance, Carpenter,
Johnson, Eastman, Gray, Groh were present at the call to order.
^PRESENTATION(S): ADVERSE CHILDHOOD EXPERIENCES
PRESENTATION(S): ADVERSE CHILDHOOD EXPERIENCES
1:30:39 PM
CHAIR VANCE announced that the only order of business would be a
presentation on Adverse Childhood Experiences (ACEs).
1:31:31 PM
TREVOR STORRS, President and CEO, Alaska Children's Trust, Co-
presented a PowerPoint, titled "HJUD ACEs" [hard copy included
in the committee packet]. He began on slide 2 by describing a
17,000-person population study conducted in California by Kaiser
Permanente. He explained that the survey asked individual and
parent participants questions in two categories: abuse and
neglect, and household dysfunction. On slide 3, he reported the
10 most common ACEs. Of the participants that were asked about
abuse and neglect, he outlined the top responses, which the
responses were physical abuse, sexual abuse, emotional abuse,
emotional neglect, and physical neglect. For participants that
were asked about household dysfunction, he said substance abuse,
parental separation/divorce, mental illness, domestic violence,
and incarceration were top in those responses.
1:34:42 PM
MR. STORRS, in response to Chair Vance, highlighted the
difference between emotional abuse and emotional neglect. Mr.
Storrs explained that emotional neglect is where a person is
holding off emotional interactions, whereas emotional abuse is
more mental in nature.
1:36:08 PM
MR. STORRS presented study results regarding ACE score
categories. He said that of the participants in the study, 33
percent reported a zero ACE score, 26 percent reported one, 16
percent reported two, 10 percent reported three, and 16 percent
reported over four ACEs. On slide 4, he said the study found
that 87 percent of ACEs occur together.
1:37:57 PM
MR. STORRS said on slides 5 and 6 that a key objective of the
study was to create and show the dose response relationship
between ACEs. He said if there's a higher dose of ACEs, there's
a higher risk of experiencing health and social problems. He
referred to slides 7-11, which shows data between the number of
ACEs and its correlation to early smoking, alcoholism, liver
disease, suicide attempts, and domestic/sexual violence.
1:41:31 PM
REPRESENTATIVE EASTMAN, in reference to the presented data on
crime perpetrators, asked what population the trust is looking
at to say that a percent of that population is correlated with
the ACEs score.
MR STORRS explained that ACEs are before the age of 18. In
response to a follow up question, he said he did not know the
number of participants who are being categorized as having
committed and perpetrated sexual violence, but he agreed to
forward the study to committee members by request of Chair
Vance.
1:44:33 PM
MR STORRS returned to the presentation on slides 12-14. He
explained that boys with an ACEs score of six or more are 46
times more likely to use IV drugs. He said they may also
struggle with employment and absenteeism. He stressed that the
study is not inclusive of all ACE adversities.
1:47:26 PM
JARED PARRISH, PhD, Senior MCH Epidemiologist, Alaska Division
of Public Health. He started his presentation about ACEs in
Alaska. He said it is critical for the committee to remember
that ACE data is self-reported by adult participants recalling
their childhood experiences before age 18. He said the division
wanted to look at what was occurring in the Alaska population.
1:51:58 PM
DR. PARRISH presented slide 18. He said individual ACEs are
common among Alaska Adults. Pointing to Centers of Disease and
Control (CDC) data from 2013-2015, he said that the top three
individual ACEs reported include: experiencing emotional abuse,
substance misuse by an adult at home, and divorce of a parent.
He moved on to slide 19 and detailed the data on the percent of
Alaska adults reporting accumulated ACEs. He said 68.4 percent
of adults in Alaska reported experiencing at least one ACE.
1:53:24 PM
CHAIR VANCE asked Dr. Parrish about a pandemic survey conducted
in Alaska by the Department of Health, and if that data was
available to overlap with the data being presented.
DR. PARRISH answered that the division does not know yet, but
said the division is trying to develop the resources and data
sources.
CHAIR VANCE asked where the data is being drawn from.
DR. PARRISH said that would be answered on the next slide.
1:55:24 PM
REPRESENTATIVE GRAY posed a hypothetical scenario where the
spouse and child leave due to abuse. He asked about the nuance
of whether the additional ACE from divorce might benefit the
child.
DR. PARRISH said the division using a broad instrument to look
at adversity in the home. He noted that there are intricacies
that are exceptions.
1:58:06 PM
DR. PARRISH talked about the Alaska Longitudinal Child Abuse and
Neglect Linkage project (ALCANLink) on slide 20. He described
the division's Pregnancy Risk Assessment Monitoring system
(PRAMS) as a population-based, mixed design survey of new
mothers. He said Alaska is one of the four states that do a
follow-up survey after three years; it gives the division
another measure where they can calculate risk to health events.
He shared that they are working on a project to bring in
"backtrack" records, as well as have an agreement with juvenile
justice data, in order to start looking at the family in a
broader context.
2:00:44 PM
REPRESENTATIVE CARPENTER asked if his understanding of the data
on slide 14 is correct. He offered his understanding that the 8
percent on the graph correlates with one ACE contributing to
absenteeism, and he asked if that is within the 17,000 person
sample. He further asked if the opposite is true in that the
remaining 92 percent that reported one ACE did not have it
contribute to absenteeism.
MR. STORRS said Representative Carpenter is correct in his
understanding.
2:02:14 PM
DR. PARRISH moved to slide 21. He explained that original ACEs
have been expanded to measure other adversities that can lead to
trauma. He said there has been work to expand and adjust ACE
scoring. He presented on slide 22 the percent of three-year-
olds experiencing accumulated ACEs. in Alaska. He reported that
47.3 percent of three-year-olds in Alaska have experienced at
least one ACE. He broke down the top four individual ACEs:
financial issues paying bills, parent job loss, substance abuse
in close family, and neglect. He presented slides 23, 24, and
25 on the impact pre-birth challenges have on early childhood
experiences. He said through ALCANLink, the division gauged
pre-birth household experiences and its connection. He said
that for each additional pre-birth challenge reported, there was
a systemic relative increase in average childhood ACE score
observed.
2:06:22 PM
DR. PARRISH moved to slides 26 and 27. He discussed changes in
household challenges and predicting maltreatment. He said the
division gauged the change of household challenges and its risk
of ACEs. He reported that a change in the number of household
challenges is associated with a change in risk of an Office of
Child Services (OCS) report. He said this is the first time the
division has evidence from a longitudinal cohort showing that,
if there is a shift in the family challenges between two time
periods, an effect on the risk of an OCS report is expected.
2:08:35 PM
REPRESENTATIVE EASTMAN asked, after the division made a
prediction, how much the ACEs score of a child change or does
not change.
DR. PARRISH replied that household challenges before the child
is born are a strong predictor of elevated ACE scores, child
maltreatment contacts, and poorer school performance.
2:10:54 PM
DR. PARRISH returned to the presentation on slides 28 and 29.
He explained how pre-birth challenges predict school readiness
and academic achievement. In gathering data about a child, he
said the division collects Alaska Developmental Profile (ADP)
data, the child's third-grade reading proficiency test, and
average attendance to track performance. He explained that, as
the number of pre-birth household challenges increase, so does
the risk of the child performing worse. He said if there are
over four birth challenges, there's a 16 percent increased risk
of not performing adequately on the ADP, a 40 percent increased
risk of scoring below or far below passing on the third-grade
reading proficiency test, and a 29 percent increased risk of
poorer attendance.
2:12:51 PM
DR. PARRISH showed a graphic on slide 30 depicting ACEs at age
three and its effect on a child's school readiness. He moved to
slide 31. He detailed the number of pre-birth challenges by OCS
cases, and explained that, as the number of screened-in cases
increase, the proportion with multiple prebirth challenges
increases. He moved to slide 32 and reported that over 50
percent of those experiencing at least one OCS removal were born
to mothers reporting two or more pre-birth household challenges.
On slide 33, he said, pre-birth household challenges have not
changed overtime. He presented a graphic with PRAMS data from
2009-2019 showing the phases of the survey.
2:16:50 PM
DR. PARRISH talked about connecting early indicators with child
outcomes on slide 34. He explained that, if a child is born to
a mother that reports she experienced partner violence, 63
percent of the children have impulse and emotional control
problems by kindergarten, 90 percent have poor third-grade
reading skills, 68 percent will be reported to OCS by age 9,
have an ACE score twice as high, and have on average of over
four co-existing stressors. He announced a new survey aimed at
adults while on slide 35. He said the goal of the new
Overcoming ACES with Resiliency (OARS) web survey is to collect
ACEs data in the context of proactive experiences at each socio-
ecological level. He said the division is beyond quantifying
how many adults are experiencing ACEs in Alaska, but now
understand how to mitigate and prevent ACEs. He shared that the
survey is planned to come out in the next month. Dr. Parrish
concluded his presentation on slides 36 and 37 by providing a
historical timeline of the ALCANLink surveys.
2:19:26 PM
REPRESENTATIVE CARPENTER asked how many people who experience
the range of negative possibilities that happen in home life,
turn out productive citizens.
DR. PARRISH responded that that is the goal of the OARS survey.
REPRESENTATIVE CARPENTER asked for further clarification on the
purpose of the survey.
DR. PARRISH explained that the overall intent is to better
understand how the division can provide support to families who
are experiencing challenges in their life. He said a critical
component is helping families have a person to support them in
their time of need.
REPRESENTATIVE CARPENTER requested Mr. Storrs to speak.
2:22:14 PM
MR. STORRS opined on quantifying prevention upstream.
REPRESENTATIVE CARPENTER questioned why it is only being
communicated that bad negative experiences lead to bad outcomes.
2:24:41 PM
DR. PARRISH acknowledged that understanding, in spite of
adversity, how people succeed and show success is critical.
However, the data source he has been using as not designed for
that intent. He said the division does not have good measures
on how to detect that.
MR. STORRS explained that the idea of the ACEs study is to
further understanding of an individual's choices in his/her
adult life and the healing process that needs to happen.
REPRESENTATIVE CARPENTER asked for data that shows if addressing
the experiences upstream via government services/funding is the
solution.
MR. STORRS asked to hold the question for later. He said the
presenters are not at the meeting to ask for more government
services, but said society and government has a role.
2:30:03 PM
CHAIR VANCE noted that the presentation is just a snapshot of
past data. She said if the data could move to measuring the
success difference in individuals who had similar experience
circumstances, it could be figured out how to start celebrating
that.
2:31:10 PM
REPRESENTATIVE C. JOHNSON asked about the sample size of mothers
in ALCANLink.
DR. PARRISH explained that one out of five live births are
sampled; total of 11,000 mothers are represented within a ten-
year period.
REPRESENTATIVE C. JOHNSON asked for further clarification on the
PRAMS three-year follow-up survey.
DR. PARRISH said PRAMS was originally designed to survey mothers
each year; in between the first and follow-up surveys, the
division is linking the participants to administrative data
sources.
REPRESENTATIVE C. JOHNSON asked if siblings have been considered
in the data.
DR. PARRISH said the division is always looking for the ideal
counter factual population to make inferences against, but
explained that in Alaska, the number of sampled repeat mothers
are too small to utilize their survey and weighted data. He
shared that the division has successfully replicated ALCANLink
in Oregon, and said he is assisting eight other states to
provide a pooled analysis on changes in families. In response
to a follow-up question, he said they must design different
models for urban and rural environments due to the difference in
factors.
2:35:09 PM
REPRESENTATIVE EASTMAN asked for, in reference to the handout,
titled "Vibrant Economy, Strong Workforce, Thriving Families
Brief" [included in the committee packet], additional
information on the estimated $1.5 million lifetime cost per
victim of fatal child abuse.
MR. STORRS said the initial collection of ACEs work began in
2016, and calculations were made of what the predicted cost of
ACEs would be. He listed the ACEs factors considered in the
cost calculations.
REPRESENTATIVE EASTMAN relayed an argument he heard that in the
case where child abuse is fatal, it may be a benefit since
government services are not needed over the course of the
child's life.
MR. STORRS asked for clarification.
REPRESENTATIVE EASTMAN said it is argued that the death is a
cost savings because the child does not need government
services.
MR. STORRS said he is unsure how to answer on the cost savings
from the death of a child.
REPRESENTATIVE EASTMAN asked if the $1.5 million estimate is
higher or lower depending on the age of the child at the time of
his/her death.
MR. STORRS said there are several factors. He repeated that the
loss of a child is immeasurable.
2:38:52 PM
DR. PARRISH interjected and explained the process of how the
cost estimate is calculated.
REPRESENTATIVE EASTMAN asked if the estimate would be different
or the same between a six month old and a newborn.
DR. PARRISH answered it would be marginally different.
2:39:47 PM
REPRESENTATIVE GROH asked Mr. Storrs how brain studies would be
helpful.
MR. STORRS said the next speaker will speak on that.
2:41:09 PM
LINDA CHAMBERLAIN, PhD, Epidemiologist/Consultant, introduced
herself. She began her part of the presentation on risk,
resiliency and neuroplasticity on slides 39 and 40. She said
her slides are not on numbers, but for understanding patterns
and implications. She moved to slide 41 and presented on
synaptic pruning. She pointed to a graphic showing the wiring
of the brain at birth, 6 years old, and 14 years old.
2:45:02 PM
DR. CHAMBERLAIN talked about the sequential development of a
child's brain, while presenting slide 42. She listed the
"building blocks" of the brain, showing a graphic that
correlates the increase in neuroplasticity with the development
the brainstem, midbrain, limbic, and cortex. She highlighted on
slide 43 how the early years are a sensitive period for
development. She moved to slide 44 to explain the markers of
positive, tolerable, and toxic stress.
2:47:45 PM
DR. CHAMBERLAIN presented a graphic on slide 45 regarding
traumatic brain development. The graphic showed the differences
between normal brain development and trauma development. She
explained that the ideal cortical modulation ratio for normal
brain development should be 2:1, and that a brain affected by
developmental trauma is at a 1:1 ratio. She showed, on slide
46, a graphic depicting an example of how they talk to families
"in an everyday way" about the thinking & learning brain, the
survival brain, and how stress affects the brain's development.
2:50:57 PM
DR. CHAMBERLAIN explained on slide 47 the effects of toxic
stress on a child's brain. She said the neural circuitry for
dealing with stress is especially malleable during childhood.
She explained that toxic stress can affect hormone and
neurotransmitter levels.
2:51:54 PM
DR. CHAMBERLAIN showed a graphic on slide 48. The graphic,
sourced from the Center on the Developing Child at Harvard
University, showed imagery on the physical impacts of persistent
stress to the prefrontal cortex and hippocampus.
2:53:24 PM
DR. CHAMBERLAIN moved to slide 50 to talk about developmental
disconnect and what behaviors were observed. She concluded her
presentation on slide 51 and said that trauma interferes with
learning.
2:54:33 PM
CHAIR VANCE thanked Dr. Chamberlain; she asked Mr. Storrs to
speak.
2:54:43 PM
MR. STORRS spoke about ACEs scores for adult and children. He
shared a quote by Dr. Rob Anda on slide 53: "What is predictable
is preventable." On slide 54 he likened life to an elastic
band, in that between positive, tolerable, and toxic stress,
each add stress to the band. Mr. Storrs discussed resilience on
slide 55. He talked about key resilient behaviors in a child.
He showed data on slide 56 regarding resilience skills and
special health care needs. He said that for each dollar
invested into early childhood upstream, the state gets 7-13
dollars back.
2:57:42 PM
MR. STORRS spoke on strategies that address the needs of
children and families. He outlined primary prevention
strategies on slides 57, 58, and 59. He listed the strategies:
connecting youth to caring adults, strengthening economic
supports, providing quality childcare & early education,
promoting culture, assisting in system navigation, fostering
healthy relationships, enhancing parenting skills, and enhancing
primary & mental health care. He concluded his presentation by
saying trauma can't be prevented, but can be predicted, and by
providing the aforementioned protective factors, could reduce
the long-term expense and impact to children and families.
3:01:28 PM
CHAIR VANCE entertained questions.
3:01:47 PM
REPRESENTATIVE GRAY thanked Mr. Storrs for the presentation. He
shared his personal experience with ACEs scores and his child.
3:02:53 PM
REPRESENTATIVE EASTMAN asked whether putting funding towards
preventing experiences like child abuse would be better for
society.
MR. STORRS said, if the state doesn't want to continually see
costs like corrections and Medicaid increase, there needs to be
investment in prevention.
3:04:05 PM
CHAIR VANCE thanked the presenters.
3:04:34 PM
ADJOURNMENT
There being no further business before the committee, the House
Judiciary Standing Committee meeting was adjourned at 3:04 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Vibrant+Economy,+Strong+Workforce,+Thriving+Families+Brief.pdf |
HJUD 2/20/2023 1:30:00 PM |
|
| HJUD ACEs Presentation.pdf |
HJUD 2/20/2023 1:30:00 PM |