For many of us, it is easy to see how our childhood experiences influence our adult choices, behaviors, and preferences. Perhaps you like basketball because all the kids on your street played together after school. Or you learned to cook by helping a beloved grandparent make special family meals. Years spent in a scouting program can create a lasting love of exploration. Examples of positive experiences are endless and unique to each of us.

In the same way, stressful or traumatic childhood events also have lasting impact. The importance of Adverse Childhood Experiences, or “ACEs”, was first discovered 20 years ago as a result of a large-scale research study led by Kaiser Permanente and the Centers for Disease Control and Prevention. The resulting ACEs screening tool established a way to gauge the cumulative effect of different types of childhood abuse, neglect or stressful events.

While adverse childhood experiences are very common, as the number of ACEs experienced by a child increase, so does that child’s risk for chronic disease as an adult. Unfortunately, as documented in the Indiana Youth Institute’s September data brief, Hoosier youth have a higher prevalence than their peers nationally in eight of out nine ACEs as measured by the National Survey of Children’s Health.

The good news is that the earlier we can identify a child’s ACEs score, the sooner we can connect them to services to prevent, reverse, or heal the effects. Both physicians and educators are building systems to screen and respond to ACEs.

In many cases, positive childhood experiences can mitigate the stressful or traumatic events. All children need adults that support, trust and love them. Caring adults, whether parents, grandparents, teachers, coaches or mentors, are key to helping children build long-term resilience.

Find more information about ACEs from the following resources:
Indiana Youth Institute ACEs Data Brief
Substance Abuse and Mental Health Services Administration
American Academy of Pediatrics

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The cumulative effect of Adverse Childhood Experiences (ACEs) has a lifelong impact on children. As the number of ACEs increases, there is a greater likelihood of negative wellbeing outcomes such as obesity, depression, and other chronic conditions throughout life.

What are ACEs? Adverse childhood experiences are stressful or traumatic events occurring in childhood and are used to assess the long-term impact of abuse and household dysfunction on later-life health.

  • Nearly half (47.3%) of Hoosier children have experienced one or more ACEs.
  • Indiana has a higher prevalence of children experiencing at least one ACE (47.3%) than half of our neighboring states: Illinois (39.7%), Michigan (46.2%), Ohio (49.5%), and Kentucky (53.1%).
  • Hoosier youth have a higher prevalence than their peers nationally in eight of out nine ACEs as measured by the National Survey of Children’s Health.

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As parents, caring adults and community leaders, we must create the conditions for healthy kids to thrive. This means recognizing and addressing the dangers children face when they live in unhealthy environments, reducing health-harming behaviors like smoking and substance use by children and around children, and building communities that make it easier for kids and families to make healthy choices about food and physical activity.

Unfortunately, Indiana comes in 35th for overall children’s health in the U.S. Recognizing this, a new statewide collaboration, the Alliance for a Healthier Indiana, is bringing together business and community leaders to address the health of our citizens. The Indiana Youth Institute is joining this important effort to support building a healthier state from the child up.

Growing up in an environment with trauma and abuse creates lasting negative effects on children’s health, including slowing a child’s social and cognitive growth, raising their likelihood for obesity, tobacco and drug use, and inflicting long term consequences to their health and life opportunities. By understanding the co-occurrence and impact of these Adverse Childhood Experiences (ACEs)*, we are better able to create positive interventions and conditions for change.

If we can reduce child and adult smoking rates, we can have a significant effect on Hoosier health. Indiana ranks 41st in the nation for the percentage of smokers, and an estimated 95 percent of adult smokers start smoking before age 21. More than 4,100 Hoosiers under age 18 become new daily smokers each year. In 2017, nine percent of Indiana high school students smoked cigarettes in the past month, and 14.9 percent of Indiana high school students used electronic vapor products. This is especially concerning, as teens who use e-cigarettes are more likely to subsequently take up cigarette smoking.

Governor Holcomb has challenged Indiana to lower its infant mortality rate, as Hoosier kids infants are 24 percent more likely to die before their first birthday than the national average. Smoking is a significant contributor to problems arising during pregnancy and in the child’s development and health. Almost 1 out of every 7 pregnant women in Indiana smokes during pregnancy, a rate that is 68 percent higher than the national average. Smoking while pregnant is associated with a higher risk of miscarriage, low birthweight, premature birth, some birth defects and Sudden Infant Death Syndrome (SIDS).

Our state’s struggle with opioid use disorder is also taking a tremendous toll on our babies and children. Newborns exposed to opioids in utero have a 60-80 percent likelihood of suffering from Neonatal Abstinence Syndrome, a condition which impacts the child’s long-term growth, behaviors, language abilities, cognitive development, and academic achievement. Last year, Indiana had one of the nation’s greatest percentage increases in the number of children being placed in foster care. The Indiana Department of Child Services reported a sizable increase in the number of substantiated cases of abuse or neglect, with over half of the removals due to parental substance abuse.

Parental overdoses have both an immediate as well as a cumulative impact on children in the home. Children double their likelihood of developing addictive disorders when they come from homes where one or more adults abuse alcohol or drugs. While we do not yet know precisely how many Indiana children are living with adults struggling with opioid use disorder, we do know that these children are suffering and that immediate interventions are needed.

The prevalence of substance use disorder has captured recent headlines, but Indiana’s struggle with obesity is a longstanding problem that we have yet to effectively address. Indiana is the 10th worst state for adult obesity rates, and 1 in 3 Indiana youth ages 10-17 are overweight or obese. According to Julie Burns, CEO of Jump IN for Healthy Kids, in central Indiana the obesity/overweight rate is 25 percent higher than the national average, and three times higher than the goal of 15 percent. Burns stresses the importance of focusing on young children, as habits around food and physical activity are developed by age 5.

Healthy kids grow up with greater chances to be healthy adults, and are more likely to become productive and successful citizens. Far too many Hoosier children face the issues caused by ACEs, smoking, opioid use, obesity and are lost due to infant mortality. We support and applaud the efforts of the Alliance for a Healthier Indiana. Local events to improve Hoosier health are taking place across the state, and we encourage everyone to find a way to contribute by going to www.healthierindiana.org. By collectively dedicating ourselves to these efforts, and by taking a multi-generational approach, we hope to increase the health and success of all Indiana residents.

syringe, pills, and spoon

Youth are the hidden victims of the opioid epidemic.

Nationally, the issue has grown so severe that in 2017, the Commission on Combatting Drug Abuse and the Opioid Crisis submitted a letter to the president requesting that the opioid crisis be declared a national emergency. In Indiana, there were 1,271 deaths from drug overdoses in 2016, a 33% increase from 2011. Drug overdoses have risen so sharply in Indiana that they now kill more Hoosiers than car crashes and gun homicides combined.

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EVERY HOOSIER ADULT IS A MANDATED REPORTER OF SUSPECTED CHILD ABUSE AND NEGLECT. TO SUBMIT A REPORT, CALL THE STATE’S HOTLINE AT 1-800-800-5556. IT’S OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR.

The number of cases of abused and neglected children in Indiana continues to grow, and 2016 marked the fifth straight year of increases. While the statistics are staggering, the individual stories are heart-wrenching. Recent cases include a 9-year-old dying from starvation in Vigo County, a 2-year-old boy beaten to death in Marion County, and a 1-year-old girl sexually abused and killed in Owen County. For every 1,000 children in Indiana, there were 17 cases of child abuse or neglect in 2015. April is National Child Abuse Prevention month and clearly more needs to be done to protect our children.

Every adult in the state of Indiana is a mandatory reporter of suspected child abuse and neglect. But how do you know what actions correspond to the legal definitions of abuse or neglect? The above cases obviously do, yet many cases are not so clear cut.  Furthermore, many children in such situations understandably are too frightened to tell anyone what is happening.

Indiana’s Child Abuse and Neglect Law, Indiana Code 31-34-1, lists definitions for child neglect, physical abuse, psychological maltreatment and sexual abuse. Prevent Child Abuse Indiana’s website, www.pcain.org, offers straightforward lists of both physical and behavioral indicators of each category of maltreatment. Signs of neglect include persistent hunger, developmental lags and consistent fatigue. Unexplained bruises, numerous bruises in various stages of healing, and marks on many surfaces of the body are all potential signs of physical abuse. Sexual abuse indicators include the child having sexual knowledge advanced for their age, preoccupation with their body, and acting out sexual behavior. Although each of these signs may be found separately, they often occur in combination.

The complexity of child abuse cases has increased in recent years, with severe physical abuse often connected to parental drug and alcohol use and mental illness in the home. In 2016, the child advocacy centers in Indiana served more than 10,000 children for the first time through their multi-disciplinary investigative team model. Historically, the majority of cases centered on child sexual abuse. Today, cases often involve parental addictions, children witnessing domestic violence and human trafficking. There also has been an increase in very severe neglect cases.

“We’re talking about the serious neglect cases where kids are locked in a room and forgotten,” said Emily Perry, founder, executive director and child forensic interviewer for child advocacy center Susie’s Place. “Parents aren’t feeding them for days or weeks because (the parents are) strung out on drugs.”

In 2016, 52 percent of children removed from their home by the Indiana Department of Child Services were removed because of parental substance abuse. This is a 65 percent increase from 2013. In 2015, DCS substantiated 2,702 cases of sexual abuse, 2,175 cases of physical abuse and 22,015 cases of neglect statewide.

As all adults are mandatory reporters, it is critical that we be familiar with how to report child abuse. A hotline report must be made if you have a reasonable suspicion that child abuse or neglect has occurred. You do not need to have direct knowledge of abuse or neglect. James Wide, ‎Deputy Director of Communications for DCS says “That’s the main, core message. You don’t have to do a lot of deliberating and thinking about ‘Is this right? Is this wrong? Is that abuse?’ Just call. You just call.” Hopefully, the increasing number of hotline calls are an indication that more Hoosiers are willing to step up and help protect our children.

Horrific stories of child abuse and neglect could easily immobilize us. Yet our children’s safety requires action. As a caring family member, neighbor, teacher, coach or youth worker, you may be in the ideal position to see that something is not right in a child’s life. Call the Indiana Child Abuse and Neglect Hotline at 1-800-800-5556. Locate your nearest Prevention Council (www.pcain.org) or Child Advocacy Center (www.incacs.org) to donate and/or volunteer. April is designated as Child Abuse Prevention Month, but the work of protecting our children is something we must all do 24 hours a day, 365 days a year.

(Tami Silverman is the president and CEO of the Indiana Youth Institute. She may be reached at iyi@iyi.org or on Twitter at @Tami_IYI)