Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

It’s time to invest in trauma-informed ACEs interventions

Vida Sandoval
Policy
July 19, 2022
Share
Tweet
Share

Last year, I witnessed the extreme consequences of untreated childhood trauma as a medical trainee rotating through multiple safety-net hospitals in Los Angeles County.

I helped care for children who arrived in our emergency departments after multiple suicide attempts due to trouble in the home. Some children confided in me about their parents’ struggle with untreated substance use or mental illness and how witnessing these conditions deeply affected them.

Other children were admitted for seizures of unknown cause that were later found to be manifestations of psychological distress — in one child related to sexual abuse, maternal abandonment, and neglect.

Overwhelming anxiety due to fears of deportation. Teenage deaths due to gang involvement. Children with unstable housing. Children rationing their food for fear of when they would next eat. I saw it all, and it was heartbreaking.

These instances exemplify the impacts of adverse childhood experiences (ACEs), which are traumatic or stressful events, including abuse, neglect, and household dysfunction that are experienced before age 18.

ACEs screening has become a major public health focus in the past several years, given the known association of ACEs with poor mental and physical health outcomes throughout life.

In January of 2020, California launched the first-in-the-nation statewide ACEs screening program, the ACEs Aware Initiative, to address the public health impact of ACEs on children throughout California.

The new bill SB 428, effective January 2022, also encouraged screening by requiring all health insurance plans to include coverage for ACE screening.

However, as ACEs screening continues to increase, simply identifying ACEs proves futile if trauma-informed interventions are not in place to address ACEs once they are identified. These interventions should implement the principles of trauma-informed care, acknowledging the effects of trauma on health and behavior and integrating this knowledge into a non-judgmental and patient-centered practice.

The literature on the long-term impacts of ACEs is well-defined and growing. ACEs are associated with risky behaviors and poor health outcomes later in life, including diabetes, hypertension, and coronary artery disease.

Having an increased number of ACEs is associated with later mental illness, problematic alcohol use, problematic drug use, and violence directed at others or oneself.

Studies have also shown an intergenerational association between parent and child ACEs scores. Given these known associations, investing in trauma-informed ACEs interventions to address traumatic childhood life experiences has the potential to impact generations and decrease poor mental and physical health outcomes. Universal ACEs screening by providers in pediatric clinics is becoming standard in California since the implementation of the ACEs Aware Initiative, but screening for ACEs is not enough.

Some researchers judiciously argue that widespread screening for ACEs should be paused until effective interventions and responses have been created to address positive screens. While ACEs screening can provide important information about the family, it can be harmful to already struggling children and families if no effective interventions are in place to address that need.

ADVERTISEMENT

The literature continues to show significant gaps in existing ACEs interventions, including lack of effective interventions and a disjointed approach to the delivery of social services for children and families identified with ACEs. We need to invest in trauma-informed interventions that center children and families and provide solutions for families who are currently navigating this complex and confusing social services system with little support.

Some may argue about the cost-effectiveness of investing in ACEs interventions, but the numbers don’t lie.

Investment in ACEs interventions represents a key opportunity given that ACEs cost California an estimated $112.5 billion annually and could cost the state over $1.2 trillion over the next decade. One study exploring the annual ACEs-associated costs across Europe and North America suggests that a 10% reduction in ACE prevalence could equate to annual savings of 3 million disability-adjusted life-years (DALYs) or $105 billion. The first step to reducing ACEs prevalence is identifying the ACE, which we are moving toward in California. Our next step is addressing that need using patient-centered and trauma-informed intervention and treatment programs.

As of November 4, 2021, over 500,000 children and adults in California had been screened for ACEs. While this represents a tremendous accomplishment, we must do more to ensure that these children and families are able to access the services necessary to address their identified ACEs.

The evidence clearly shows that ACEs are extremely harmful to children’s developmental, physical and mental health. We have responded to this evidence by increasing ACEs screening. Now, we must invest in trauma-informed interventions to help address these ACEs.

I want to see a comprehensive intervention system that centers on children and families and aims to address these needs early in the child’s life. I want to see more families trusting their pediatricians with ACEs information because they know they will receive the help that they deserve. I want to see fewer children struggling with mental illness, attempting suicide, and dying due to violence from unresolved childhood trauma. Don’t you?

Vida Sandoval is a medical student.

Image credit: Shutterstock.com

Prev

Chaos and order: the simulated context

July 19, 2022 Kevin 0
…
Next

The "golden consult" revisited

July 19, 2022 Kevin 2
…

Tagged as: Psychiatry, Public Health & Policy

Post navigation

< Previous Post
Chaos and order: the simulated context
Next Post >
The "golden consult" revisited

ADVERTISEMENT

Related Posts

  • Doctors: It’s time to unionize

    Thomas D. Guastavino, MD
  • Finding happiness in the time of COVID

    Anonymous
  • Why is trauma activation so expensive?

    Skeptical Scalpel, MD
  • Are behavioral economic interventions the key to health system improvement?

    Peter Ubel, MD
  • A medical student’s reflection on time, the scarcest resource

    Natasha Abadilla
  • It’s time to ban productivity from medicine

    Robert Centor, MD

More in Policy

  • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

    AMA Committee on Economics and Quality in Medicine, Medical Student Section
  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...