Applied Evidence

Childhood adversity & lifelong health: From research to action

J Fam Pract. 2018 November;67(11):690-699

References

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20. Rostad WL, Basile KC, Clayton HB. Association among television and computer/video game use, victimization, and suicide risk among U.S. high school students. J Interpers Violence. 2018 Mar 1:886260518760020.

21. Coyne SM, Nelson DA, Graham-Kevan N, et al. Media depictions of physical and relational aggression: connections with aggression in young adults’ romantic relationships. Aggress Behav. 2011;37:56-62.

22. Centers for Disease Control and Prevention. Violence prevention: Child abuse and neglect: risk and protective factors. April 10, 2018. www.cdc.gov/violenceprevention/childabuseandneglect/riskprotectivefactors.html. Accessed October 10, 2018.

23. Miller TR. Projected outcomes of nurse-family partnership home visitation during 1996-2013, United States. Prev Sci. 2015;16:765-777.

24. Prinz RJ, Sanders MR, Shapiro CJ, et al. Population-based prevention of child maltreatment: the U.S. Triple P system population trial. Prev Sci. 2009;10:1-12.

25. Kraft C. Building capacity & support for two generation primary care. 2015 Midwest Regional Summit on Adverse Childhood Experiences. March 13, 2015. www.hmprg.org/assets/root/PDFs/2015/Summit%20Notes%20for%20Day%20Two.pdf. Accessed September 20, 2018.

26. Smith MV, Gotman N, Yonkers KA. Early childhood adversity and pregnancy outcomes. Matern Child Health J. 2016;20:790-798.

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28. Bethell CD, Carle A, Hudziak J, et al. Methods to assess adverse childhood experiences of children and families: toward approaches to promote child well-being in policy and practice. Acad Pediatr. 2017;17:S51-S69.

29. Wade R Jr, Becker BD, Bevans KB, et al. Development and evaluation of a short adverse childhood experiences measure. Am J Prev Med. 2017;52:163-172.

30. Rush P. How learning about emotional trauma led me to a new understanding of chronic illness and health disparity. Becoming trauma-informed: Perspectives from public health, faith communities, education and medicine. Presented at 2016 Advocate Symposium, “Becoming a Trauma-Informed Children’s Hospital and Community: Building Foundations of Care, Collaboration and Practice.” Oaklawn, IL: Advocate Children’s Hospital; November 16, 2016.

31. Diderich HM, Fekkes M, Verkerk PH, et al. A new protocol for screening adults presenting with their own medical problems at the Emergency Department to identify children at high risk for maltreatment. Child Abuse Negl. 2013;37:1122-1131.

32. Fact Sheet: Key ingredients for trauma-informed care. Center for Health Care Strategies, Inc. August 2017. www.chcs.org/media/ATC-Key-Ingredients-Fact-Sheet_081417.pdf. Accessed September 22, 2018.

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34. Perry BD. Understanding traumatized and maltreated children: the core concepts. Child Trauma Academy Video Training Series, Video 4;2004:12. Child Trauma Academy (http://childtrauma.org/).

35. Perry BD. Understanding traumatized and maltreated children: the core concepts. Child Trauma Academy Video Training Series, Video 4;2004:19. Child Trauma Academy (http://childtrauma.org/).

36. EMDRIA’s definition of EMDR (eye movement desensitization and reprocessing). Austin, TX: EMDRIA: EMDR International Association. http://c.ymcdn.com/sites/www.emdria.org/resource/resmgr/imported/EMDRIA%20Definition%20of%20EMDR.pdf. Revised February 25 2012. Accessed September 21, 2018.

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53. Bryan M. A hospital offers frequent ER patients an out—free housing. “All Things Considered.” National Public Radio. June 29, 2016. www.npr.org/sections/health-shots/2016/06/29/482994000/a-hospital-offers-frequent-er-patients-an-out-free-housing. Acces-sed September 20, 2018.

Triple P. A randomized controlled trial of Triple P, an evidence-based, multilevel, population-based preventive intervention system that was designed to support parents and enhance parenting practices for families with at least 1 child (birth to 12 years old), demonstrated a statistically significant reduction in substantiated child maltreatment cases, out-of-home placements, and emergency room visits and hospitalizations for childhood injuries that were the result of child maltreatment.²⁴

The Family-Centered Medical Home, a primary care strategy to reduce premature and low-birth-weight deliveries, used Medicaid dollars for services not traditionally considered “medical” to address all physical and emotional needs of mothers and families as part of the medical relationship. This program eliminated premature delivery and low birth weight,²⁵ both considered evidence of in utero toxic stress.²⁶

Screening can be brief: In some cases, a single question

The prevalence and impact of childhood adversity, along with the opportunity for significant health improvements and savings, inspires providers to explore screening. Existing screening programs have consistent goals^27,28:

identify unique experiences shaping our patients’ health
reframe “What’s wrong with you?” as “What happened to you?” “What’s right with you?” and “What matters to you?”
facilitate health education and neuro-education, particularly meaning-making and self-regulation
prevent and mitigate the sequelae of exposure to ACEs
promote health in this and subsequent generations.

The ACE Study screened patients in the context of a comprehensive periodic health assessment. Study participants completed an at-home questionnaire and reviewed it with their physician.¹ The Urban ACE Survey added important community stressors such as neighborhood violence, bullying, and food insecurity to the original ACE questionnaire.²

Primary care tool. Wade developed a short, 2-question ACE pre-screener for primary care²⁹ and is exploring screening for childhood adversity in pediatric practice, as are primary care clinicians around the country.

Continue to: Single-question screener