The Brain Story Certification: Module 11

Module 11: ACEs, Part B – Using the Science of ACEs in Practice

 

Excerpt from “The Progressive Nature of Adverse Childhood Experiences: Building Self-Healing Communities” Robert Anda, MD, MS Centers for Disease Control and Prevention

• Systems are well-intentioned, but they do fit well with the impacts of adversity.
• More likely to fail a grade with 3 or more aces (2.5x)
• Findings of the prevalence of various ACES scores to fit across many different regions.
• Often is a one-size-fits-all approach in schools, not recognizing the impacts of trauma in schools.
• Schools have a role to play in addressing trauma.
• Impacts on felonies and reoffences
• 70% have some type of DSM diagnosis – with 72% of those individuals have co-occurring substance use disorders.
• Poverty is an ACE and it creates an environment where ACES can take place.
• Many are disabled to the point that they are unable to work.
• Early trauma and stress lead to child development that has impact on the brain function, which has an effect on mental health and developmental delays.
• Do children have ADD/ADHD or childhood PTSD?
• Into adulthood, the adversity remains, creating parents who enter a cycle for adversity in the next generation.

Excerpt from “What Are ACEs?” Vincent Felitti, MD Kaiser Permanente

• Be watchful for sexual abuse, humiliation, incest, rape, and childhood brutality – chronic depression/anxiety, living with chronic alcoholic/substance users.
• Questionnaires are an excellent way to get the information for what is needed to be a good interviewer for gaining formation.
• Understand the primary problem to which addiction is the underlying solution
• Focus on supportive group work
• Provide long-term support.
• Lengthy questionnaires with comprehensive history – looking at unconventional questions.
• Trauma-oriented approach – 11% reduction in doctor office visits in the subsequent year
• Biopsychosocial evaluation – 35% reduction in doctor office visits in the subsequent year.
• Routinely seek a history of adverse childhood experiences from all participants by questionnaire.
• Acknowledge the client’s reality
• Use existing systems to help with current problems.
• Develop systems for primary prevention.

Excerpt from “Using the ACE Questionnaire in Practice” Rahil Briggs, PsyD Healthy Steps at Montefiore

• Current assessments ACES, ASQ: SE, PHQ-9
• Do universal screening, assessment, treatment, and referral of infant and caregiver mental health.
• Have a good education for providers
• Provide on-site education
• A lot of the interventions of pediatrics are through the parent – the same logic applies to work with parents in this capacity.
• Annual review of ACES with child/parent
• Parents’ own ACES score is a good indicator for the child.
• See what toxic stress may look like for the child.
• Link of ACES and adverse health factors.
• Healthy emotional/social development refers to the child’s ability to experience/manage/express the full range of positive and negative emotions.
• Develop close, satisfying relationships with other children and adults, and actively explore the environment and learn—this aids in school readiness.
• ASQ: SE (3-60 months) – personal-social domains, 8 colour-coded sections
• Co-management of well-child visits, baby and me group, home visits, and adult mental health services.
• Has implications for emergency room visits.
• Those with an early exit from programming tended to have depression and/or less education.
• If the parent had abuse in their life, the child has a higher risk of increase ACES and developmental impacts.
• “Healthy Steps” serves as a moderator between intergenerational transmission of ACES – further research needed.

Excerpt from “Using the ACE Questionnaire in Practice” Rahil Briggs, PsyD Healthy Steps at Montefiore

• Universally asking questions of questions
• Need to be provided to primary care providers. Confidentiality and consent for access can be discussed with the client.
• Normalize the use and place it in the context of whole-person healthcare.

Excerpt from “Using the ACE Questionnaire in Practice” Rahil Briggs, PsyD Healthy Steps at Montefiore

• Adult cost savings are more money-saving in prevention than child mental health in the short-term. In the long-term, the cost-savings of interventions for children.
• Can use ACES can be a strengths-based approach – how do we keep the ACES score at a 1?
• Integrate mental health workers in the primary care network.