Childhood adversity &amp; lifelong health: From research to action

,

Applied Evidence

Childhood adversity & lifelong health: From research to action

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

PDF Download

References

1. Felitti V, Anda R. The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: implications for healthcare. In: Lanius RA, Vermetten E, Pain C, eds. The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic. Cambridge, UK: Cambridge University Press; 2011:77-87.

2. Wade R Jr, Shea JA, Rubin D, et al. Adverse childhood experiences of low-income urban youth. Pediatrics. 2014;134:e13-e20.

3. Centers for Disease Control and Prevention. Child abuse and neglect prevention. April 10, 2018. www.cdc.gov/violenceprevention/childabuseandneglect/index.html. Accessed September 20, 2018.

4. American Academy of Family Physicians. Definition of family medicine. www.aafp.org/about/policies/all/family-medicine-definition.html. Accessed March 5, 2018.

5. Martin JC, Avant RF, Bowman MA, et al; The Future of Family Medicine Project Leadership Committee. The Future of Family Medicine: a collaborative project of the family medicine community. Ann Fam Med. 2004;2 Suppl 1:S3-S32.

6. Child & Adolescent Health Measurement Initiative (CAHMI). A national and across-state profile on Adverse Childhood Experiences among U.S. children and possibilities to heal and thrive. Issue Brief. October 2017. www.cahmi.org/wp-content/uploads/2018/05/aces_brief_final.pdf. Accessed September 20, 2018.

7. World Health Organization. Adverse Childhood Experiences International Questionnaire (ACE-IQ). www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_experiences/en/. Accessed September 20, 2018.

8. Roos LE, Mota N, Afifi TO, et al. Relationship between adverse childhood experiences and homelessness and the impact of axis I and II disorders. Am J Public Health. 2013;103(Suppl 2):S275-S281.

9. Baglivio MT. Wolff KT. Piquero AR, et al. The relationship between adverse childhood experiences (ACE) and juvenile offending trajectories in a juvenile offender sample. J Crim Justice. 2015;43:229-241.

10. Dube SR. Felitti VF. Dong M, et al. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics. 2003;111:564-572.

11. Maunder RG, Peladeau N, Savage D, et al. The prevalence of childhood adversity among healthcare workers and its relationship to adult life events, distress and impairment. Child Abuse Negl. 2010;34:114-123.

12. Anda RF, Felitti VJ, Bremner JD, et al. The enduring effects of abuse and related adverse experiences in childhood: a convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006;256:174-186.

13. Braveman PA, Cubbin C, Egerter S, et al. Socioeconomic disparities in health in the United States: what the patterns tell us. Am J Public Health. 2010;100(Suppl 1):S186-S196.

14. Bowers ME, Yehuda R. Intergenerational transmission of stress in humans. Neuropsychopharmacology. 2016;41:232-244.

15. Perry BD. Memories of fears: How the brain stores and retrieves traumatic experiences. In: Goodwin J, Attias R, eds. Splintered Reflections: Images of the Body in Trauma. New York, NY: Basic Books; 1999:9-38.

16. Perry BD. Examining child maltreatment through a neurodevelopmental lens: clinical application of the Neurosequential Model of Therapeutics. J Loss Trauma. 2009;14:240-255.

17. Adverse childhood experiences presentation graphics. The ACE Pyramid. CDC National Center for Injury Prevention and Control, Division of Violence Prevention. April 1, 2016. www.cdc.gov/violenceprevention/acestudy/ACE_graphics.html. Accessed October 10, 2018.

18. Adding layers to the ACEs pyramid—What do you think? Trauma and social location. ACES Connection, RYSE Center. 2015. www.acesconnection.com/blog/adding-layers-to-the-aces-pyramid-what-do-you-think. Accessed October 10, 2018.

19. Berens AE, Jensen SKG, Nelson CA 3rd. Biological embedding of childhood adversity: from physiological mechanisms to clinical implications. BMC Med. 2017;15:135.

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.

27. Leitch L. Action steps using ACEs and trauma-informed care: a resilience model. Health & Justice. 2017;5:1-10.

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.

33. Adversity. In: Merriam-Webster Online Dictionary. Springfield, MA: Merriam-Webster, Inc. www.merriam-webster.com/dictionary/adversity. Accessed September 21, 2018.

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.

37. Types of trauma and violence: Historical trauma. Washington, DC: Substance Abuse and Mental Health Services Administration. www.samhsa.gov/trauma-violence/types. Accessed September 21, 2018.

38. Hammond DC. What is neurofeedback? An update. J Neurotherapy. 2011;15:305-336.

39. International Neuromodulation Society. Neuromodulation, or neuromodulatory effect. www.neuromodulation.com/neuromodulation-defined. November 9, 2017. Accessed September 21, 2018.

40. World Health Organization. Social determinants of health. www.who.int/social_determinants/sdh_definition/en/. Accessed September 21, 2018.

41. Davis R, Pinderhughes H, Williams M. Adverse community experiences and resilience: a framework for addressing and preventing community trauma. Oakland, CA: Prevention Institute; 2015:4-5. www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing. Accessed September 30, 2018.

42. SAMHSA-HRSA Center for Integrated Health Solutions. Trauma. Rockville, MD: Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration, US Department of Health and Human Services. www.integration.samhsa.gov/clinical-practice/trauma. Accessed September 21, 2018.

43. Cohen JA, Mandarino AP. Trauma-focused cognitive behavioural therapy for children and parents. Child Adolesc Ment Health. 2008;13:158-162.

44. Trauma-informed approach and trauma-specific interventions: Trauma-informed approach. Washington, DC: National Center for Trauma Informed Care and Alternatives to Seclusion and Restraints; Substance Abuse and Mental Health Services Administration. www.samhsa.gov/nctic/trauma-interventions. Accessed September 21, 2018.

45. Perry BD. How the brain develops: the importance of early childhood. Child Trauma Academy Video Training Series, Video 1;2004:21. Child Trauma Academy (http://childtrauma.org/).

46. Huang LN, Sharp CS, Gunther T. It’s just good medicine: trauma-informed primary care. (SAMHSA-HRSA Center for Integrated Health Solutions webinar); August 6, 2013. www.integration.samhsa.gov/about-us/CIHS_TIC_Webinar_PDF.pdf. Accessed September 20, 2018.

47. CHCS: Center for Health Care Strategies, Inc. Fact sheet: Key ingredients for trauma-informed care. August 2017. www.chcs.org/media/ATC-Key-Ingredients-Fact-Sheet_081417.pdf. Accessed September 20, 2018.

48. National Council for Behavioral Health. Trauma-informed primary care: fostering resilience and recovery. www.thenationalcouncil.org/consulting-areas-of-expertise/trauma-informed-primary-care/. Accessed September 20, 2018.

49. Child Trauma Academy. The Neurosequential Model of Therapeutics as evidence-based practice. https://childtrauma.org/wp-content/uploads/2015/05/NMT_EvidenceBasedPract_5_2_15.pdf. Accessed September 30, 2018.

50. Bisson JI, Ehlers A, Matthews R, et al. Psychological treatments for chronic post-traumatic stress disorder. Systematic review and meta-analysis. Br J Psychiatry. 2007;190:97-104.

51. Metcalf O, Varker T, Forbes D, et al. Efficacy of fifteen emerging interventions for the treatment of posttraumatic stress disorder: a systematic review. J Trauma Stress. 2016;29:88-92.

52. van der Kolk BA, Hodgdon H, Gapen M, et al. A randomized controlled study of neurofeedback for chronic PTSD. 2016; PLoS One. 2016;11:e0166752.

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