To set in motion the Pediatric Symposium at the 2018 National ACEs Conference in San Francisco, Dr. Nadine Burke Harris, founder and CEO of the Center for Youth Wellness, told the audience of several hundred attendees that the American Academy of Pediatrics has made it very clear to its membership how critical it is that every pediatrician understand how toxic stress impacts the health of their patients. But, she said, when it surveyed its membership it found that only 11 percent knew about ACEs, and of those only 4 percent were screening their patients for toxic stress.
And then came the kicker: At the first National ACEs conference in 2016 very few pediatricians were screening for Adverse Childhood Experiences (ACEs), Burke Harris explained. “Now more than 600 of you are doing this!” she said.
She reminded those attending, many of whom are members of CYWs National Pediatric Practice Community on ACEs (NPPC), that CYW’s “bold goal,” is essentially for a paradigm shift, one that would lead to universal ACEs screening within a decade. “My number one message today,” said Burke Harris, is: This is doable!”
One way of building momentum around ACEs screening and intervention, according to Center for Youth Wellness Chief Medical Officer Jonathan Goldfinger is by speaking out publicly. When federal policy led to separating families, Goldfinger noted, “Nadine and [AAP President] Colleen Craft testified before Congress that this is wrong because we’re traumatizing children. We’re not saying this because we’re advocates, we’re saying this because the data is incontrovertible for health outcomes,” he relayed to a burst of applause.
And to reach the goal of universal screening another crucial piece, according to Dr. Monica Bucci, the director of research at the Center for Youth Wellness, is building scientific evidence that shows over time and with more specificity how toxic stress from ACEs harms health. As an example, Bucci explained that research is underway into the best biomarker and behavioral measures to show the impact of toxic stress on an individual child, how feasible these tests are in a pediatric practice and how acceptable these tests are to parents. (To learn more about biomarker research, see this story.)
While some areas of science into ACEs and toxic stress are still in process, there’s already solid research to show the benefit of building up support systems for parents to prevent ACEs in their children, according to Dr. Rachel Gilgoff, CYW’s interim clinical innovations researcher. The issue here is not the science, she explains. it’s more about raising awareness so that doctors ask parents the right questions. For example, to learn if a parent is isolated, she asks, “How often do we ask, ‘if you’re sick, who can bring you chicken soup?’ We know that social integration has a dose-dependent health effect.”
To learn the nuts and bolts of how ACEs science works in pediatric practices, panelists from across the country who were part of the NPPC pilot study on screening for ACEs offered tips from the trenches. “I would say get your senior leadership involved early on, and give them the science, find a champion and give them a reason to say yes,” said Dr. Andria Ruth of the Santa Barbara Neighborhood Clinics. The clinics’ Chief Operating Officer, Nancy Tillie, was also on the panel. Ruth said she had returned from the first ACEs conference declaring to Tillie “They had to train everyone in trauma-informed care.” But Tillie said she had already been won over by Nadine Burke Harris’s Ted Talk.
Dr. Mercie DiGangi did not have it as easy as Ruth in convincing leadership. Her immediate supervisor at Kaiser Permanente Southern California in Downey was all in, but then DiGangi, who is the regional chair for the Child Abuse Prevention Program, faced obstacles. ”Every group I had presented to within the Kaiser system had never heard of ACEs,” she said. The solution? Education.
DiGangi said after she gave presentations on ACEs and how ACEs affects their patients she had complete buy in. Then more pushback. They asked her, she said, ”How do we do it so providers don’t get stressed, and patients get the help they need?” DiGangi was ultimately allowed to pilot ACEs screening at her pediatric clinic, where patient’s families are educated about ACEs and offered counseling if they need support. The lesson? “Start large and scale down,” said Digangi.