5 Things to Know as California Starts Screening Children for Toxic Stress [californiahealthline.org]


By Barbara Feder Ostrov, California Healthline, January 7, 2020

Starting this year, routine pediatric visits for millions of California children could involve questions about touchy family topics, such as divorce, unstable housing or a parent who struggles with alcoholism.

California now will pay doctors to screen patients for traumatic events known as adverse childhood experiences, or ACEs, if the patient is covered by Medi-Cal — the state’s version of Medicaid for low-income families.

The screening program is rooted in decades of research that suggests children who endure sustained stress in their day-to-day lives undergo biochemical changes to their brains and bodies that can dramatically increase their risk of developing serious health problems, including heart disease, asthma, depression and cancer.

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I am new to this community.  I completely understand the worry for this overloading the current system.  We are beginning a full fledged systems change for medical care, because the research demands that we pay attention to what we now know about ACEs, serious health risks and an attack on resiliency.  We need everyone to be versed in trauma and resilience language and actions. My passion is in understanding and maximizing  resiliency across the lifespan.

I think Dr. Finkelfor is right, there will be fall out, but its worth it because we can't do something so important perfectly the first time around.  We learn from our failures and then fine-tune as we go.  Humans are not as fragile as we think. We certainly do not want to exploit childhood, but we need to be brave enough to talk about Adverse Childhood Experiences, in childhood, if possible.

D.W. Winicott taught us that we just need to be "good enough" parents, not perfect.  If we think of this as a start.  It's a way to build resilience and provide enough support, through clinical strategies in office; i.e, support groups, reflective consultation, resources like stipends, food, medical care, education, high quality child care etc. The path will become more obvious as we go forward and get outcomes. It is important to remember that "need" precedes funding.   

We have to start somewhere, we know better now, so we have to start doing better! Ignoring the obvious is more damaging than trying to help the situation, but failing in some areas is inevitable.

I agree that it is going to be critical to train the front-line (screeners; MDs, MAs, NPs, Nurses, or others) in the necessary clinical strategies to address particular ACEs profiles.  This will be the key to success.  It might take a minute to get there, but we are in a systems change mode and we have make medical care integrate more emotional care.  I hope that physicians are beginning to think about creating more supports in-house.  The kind of supports that increase awareness of ACEs and build resilience.   

E. Werner taught us that just one caring relationship, where one is "seen" is the most powerful protective factor for future resilience. If we make the medical home, the base camp for that kind of relationship and nourished that relationship then we start the ripple effect and will inadvertently bring more supports into the circle.   

This is just one persons perspective, but I believe we are in the process of systems change and it is time that we start integrating the physical and emotional health of the whole person to better the quality of life for not only that patient, but this is also how we build much more resilient families and communities. ~Dr. B

As always, Dr. Finkelfor says things others might be too afraid to say: Here he points out that although it's a good thing to recognize the impact of adversities on child wellbeing, we are moving too fast and don't yet know what best practices are. He cautions that this could have "disastrous consequences.” It flies in the face of trauma informed care to possibly add injury to those already burdened with adversity. 

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