information for transformational people

Consultation 246Launch of screening for children and adults for trauma 

From an article by Center for Youth Wellness, California

In 2020, California planned a campaign to train tens of thousands of health providers to screen children and adults up to age 65 for trauma. It is well-established that the early identification of trauma and providing the appropriate treatment are critical tools for reducing long-term health care costs for both children and adults. Research (see the blog on Adverse Childhood Experiences) has shown that individuals who experienced a high number of traumatic childhood events are likely to die nearly 20 years sooner than those without these experiences.

The founder of the Center, Dr. Nadine Burke Harris illustrates by recalling a 10-year-old patient whose asthma was extraordinarily difficult to control. After yet another flare-up, she sat down with the mother to scrutinize the girl’s medication regimen. Asking if there was any trigger they hadn’t yet identified, the mother mused, ‘Well, her asthma does seem to get worse whenever her dad punches a hole in the wall. Do you think that could be related?”

Nadine did. She went on to find research that found that children who have experienced domestic violence, abuse, neglect, parental mental illness and other adverse childhood experiences (ACEs) were more likely to develop numerous health problems later in life, including cancer, depression, suicide, alcohol and drug abuse, and diabetes. The more such experiences they had, the greater their risk of developing these conditions.

[WOTS comment: The cost to individuals and society is huge down the line. A 2019 report in the Lancet estimated these as follows, "Total annual costs attributable to ACEs were estimated to be US$581 billion in Europe and $748 billion in north America. More than 75% of these costs arose in individuals with two or more ACEs. Millions of adults across Europe and north America live with a legacy of ACEs. Our findings suggest that a 10% reduction in ACE prevalence could equate to annual savings of $105 billion."]

Now, once trained, every public-health provider in California can begin to ask parents or children a few questions to find out if an individual child has been exposed to violence as well as discrimination, housing instability, food insecurity, parent-child separation and other adversities in their home or community. Healthcare providers will not only be reimbursed for the time they spend doing this work, they’ll get advice on how to best screen and help families of children who have had these experiences.

This is great news. But it has also stoked some anxiety among doctors, child advocates and other healthcare providers who would carry out this work over the unintended consequences of ACEs screening, and how can these be avoided. Trauma screening requires more than a clinician with a clipboard and a pencil — or an iPad.

To counter concerns, evidence-based and evidence-informed tools and interventions from various pilots are being used to work with individuals, families and communities exposed to childhood trauma. Also the initiative starts by doing research to deeply understand a community — its needs, demographics, key influencers, and potential barriers to trauma screening and treatment. They then partner with the community’s key stakeholders in three ecosystems (providers, parents/caregivers, and community-based organizations) to develop a theory of action. 

Trauma screening should support families, not stigmatize them. The purpose of the screening questions is to ensure that children who have had these harmful experiences get help. Logging only the number of these negative experiences without specifying which ones they’ve been through, will alleviate the anxiety of some parents and cut down on inappropriate referrals to child welfare authorities.

There are many ways to help children and families with trauma that are supported by evidence. For example, researchers from UCLA and Cincinnati Children’s Hospital Medical Center in Ohio have found that peer-to-peer parent coaches, parental self-care, a strong support network, and creating consistent, enjoyable family routines can all help kids and families who are facing adversity and/or toxic stress.

Supporting the parent-child relationship is essential. A recent systematic review published in the American Journal of Preventive Medicine found that it’s crucial to support the parent-child relationship. The review found that parenting education, social support referrals, mental health counselling and connecting families to community-based services made a significant difference in the outcomes of children exposed to ACEs. Science also shows that the key domains of wellness — sleep, nutrition, exercise, nature, healthy relationships, mental health and mindfulness — can also help reduce and heal toxic stress resulting from trauma, so getting this knowledge out to parents is crucial.

The community is also part of the “treatment” solution. Schools, day care and related settings can play an essential role in addressing the impact of traumatic stress on students “by providing prevention, early intervention, and intensive treatment for children exposed to trauma,” according to a 2018 article in Ethnicity and Disease.

Read the full article here.

What could be the outcome? Here is the result of one pilot:
ACE Study questions relating to traumatic life experiences in childhood were added to the comprehensive medical history questionnaire that patients filled out at home. An analysis of 135,000 consecutive adults going through Health Appraisal in a 2.5-year period revealed that the addition of these trauma-oriented questions, with follow-up in the exam room produced a 35% reduction in outpatient visits and an 11% reduction in Emergency Department visits over the following year compared with that group’s prior year utilization. At last, someone listened to what they had been through..

Should the NHS introduce such screening here?

Churches can help raise community awareness of ACEs and help facilitate community actions via the Resilience Challenge, when Covid restrictions permit. Note also the importance of parenting education. Something churches are actively involved in.

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From an article by Center for Youth Wellness, Cali, 09/12/2020

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