Insurers are continuously looking for ways to strengthen their understanding of the physical, psychological and social barriers that can contribute to difficulties in recovering from a disability, delaying or even preventing recovery and possible return-to-work.
Seasoned claims managers are generally highly skilled at asking the right questions during case interviews in order to determine any physical and emotional conditions that might result in longer claim durations and poorer RTW outcomes. However, a set of conditions that has recently begun receiving greater notice are the adverse childhood experiences – abuse, neglect and family dysfunction – that may occur during the first 18 years of life.
ACEs are a growing concern for insurers for several reasons. ACEs can have a substantial and deleterious impact on juvenile brain development. Researchers have found that high levels of stress hormones such as adrenaline and cortisol can damage brain structure and function in young people, resulting in ongoing difficulties into adulthood in learning, building trust and healthy relationships, detecting threats, and regulating emotions.
Second, ACEs are far more common than has generally been thought. The Adverse Childhood Experiences Study, a study conducted from 1995-1997 on the effect of childhood trauma by the Centers for Disease Control and Prevention and Kaiser Permanente, found that nearly two-thirds of its more than 17,000 participants (all of whom were Southern California-based Kaiser members) had at least one ACE, and more than 20% had three or more.
Third, ACEs can impact an adult’s general health, including the ability to recover from injury. The magnitude of their impact, according to the CDC/Kaiser study, depended on the types of abuse experienced (emotional, physical/sexual and/or neglect), the family issues that might have played a role in the perpetration of the abuse (parent or sibling substance use, mental illness, incarceration; parental separation or divorce, family violence), and the individual’s age when the abuse took place, as different areas of juvenile brains develop at different times.
In the study, participant responses were scored from 0 to 10, with 10 reflecting the highest amount of cumulative childhood stress. A 2009 paper in The American Journal of Preventive Medicine discussed a review of the CDC/Kaiser study results that incorporated follow-up mortality and morbidity data.