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A growing movement working to understand and address the impact of adverse childhood experiences (ACEs), has launched the issue into the forefront of pediatric health care and is even influencing broad state policy decisions. Recently, California Governor Gavin Newsom appointed Dr. Nadine Burke Harris as the state’s first surgeon general. Dr. Burke Harris, an expert on the impact of trauma on children’s physical and mental health, is leading efforts to incorporate trauma informed principles into providers’ offices, schools and other places that serve children and families.
Researchers, including Dr. Burke Harris, have found that traumatic events, like parental substance misuse or divorce, can have lifelong impacts on a child’s mental and physical health. We also know that the burden of ACEs falls disproportionately among certain groups: typically low-income children of color who face more adversity than their white counterparts. Despite the substantial body of evidence of trauma’s impact on children, the pediatric community is still reaching a consensus on how to effectively address the long-term effects of adversity early in life.
Although there continues to be debate on how best to address ACEs, many pediatric providers are taking steps to incorporate the science of trauma into their work. Pediatric providers have identified two main approaches to addressing traumatic experiences and building resilience: integrating ACEs screenings into regular checkups and restructuring existing practices to make space for effective methods of interventions. However, there continues to be disagreement over the appropriate age of screening and whether to screen parents, children or both. Additionally, no evidence-based interventions are being widely used, so there continues to be concern over the use of screening without referral to adequate follow-up services.
Even with this uncertainty, pediatric providers and advocates can work together to begin incorporating interventions for children experiencing ACEs into pediatric settings. Comprehensively altering pediatric practice environments can require policy changes at the local, state and federal levels. Advocates play a key role in driving policy priorities that can help health practices shift their structures to support children and families who have experienced trauma. Advocates can assist practitioners in moving toward trauma-informed care delivery using these four policy priorities:
- Align Payment and Delivery of Care: secure covered benefits that address trauma and embed trauma-informed approaches into payment and delivery system reform
- Collect and Disaggregate Data: strengthen data collection to monitor the prevalence of ACEs, drive a response, and help identify and establish the best treatment methods
- Develop Evidence-Based Practices: advance and share evidence-based screening practices
- Ensure Workforce Development: train clinicians and staff to be equipped with the knowledge and skills to address ACEs
Addressing ACEs requires a multi-pronged approach to ensure that children are not negatively impacted by the experiences of their childhood. While providers can work to respond to trauma in their practices, advocates can support this work by pushing for policy changes. For a deeper look at how providers and advocates can work together to address ACEs, take a look at our new issue brief.
Guest Blogger: Sivi Satchithanandan, Intern, Community Catalyst