Childhood adversity &amp; lifelong health: From research to action

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Applied Evidence

Childhood adversity & lifelong health: From research to action

J Fam Pract. 2018 November;67(11):690-699

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References

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23. Miller TR. Projected outcomes of nurse-family partnership home visitation during 1996-2013, United States. Prev Sci. 2015;16:765-777.

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25. Kraft C. Building capacity & support for two generation primary care. 2015 Midwest Regional Summit on Adverse Childhood Experiences. March 13, 2015. www.hmprg.org/assets/root/PDFs/2015/Summit%20Notes%20for%20Day%20Two.pdf. Accessed September 20, 2018.

26. Smith MV, Gotman N, Yonkers KA. Early childhood adversity and pregnancy outcomes. Matern Child Health J. 2016;20:790-798.

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28. Bethell CD, Carle A, Hudziak J, et al. Methods to assess adverse childhood experiences of children and families: toward approaches to promote child well-being in policy and practice. Acad Pediatr. 2017;17:S51-S69.

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30. Rush P. How learning about emotional trauma led me to a new understanding of chronic illness and health disparity. Becoming trauma-informed: Perspectives from public health, faith communities, education and medicine. Presented at 2016 Advocate Symposium, “Becoming a Trauma-Informed Children’s Hospital and Community: Building Foundations of Care, Collaboration and Practice.” Oaklawn, IL: Advocate Children’s Hospital; November 16, 2016.

31. Diderich HM, Fekkes M, Verkerk PH, et al. A new protocol for screening adults presenting with their own medical problems at the Emergency Department to identify children at high risk for maltreatment. Child Abuse Negl. 2013;37:1122-1131.

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53. Bryan M. A hospital offers frequent ER patients an out—free housing. “All Things Considered.” National Public Radio. June 29, 2016. www.npr.org/sections/health-shots/2016/06/29/482994000/a-hospital-offers-frequent-er-patients-an-out-free-housing. Acces-sed September 20, 2018.

Single-question screener. A Chicago internist interviewed more than 500 patients using a single-question screener that asked whether growing up was “mostly okay or pretty difficult.” This tool accurately confirmed childhood adversity in patients with complex chronic illness, prevented re-traumatization by allowing patients control over disclosure, and opened the door to collaborative healing work over time.³⁰

The Hague Protocol, now mandated in the Netherlands for health and justice professionals, focuses its efforts upstream by offering early detection of children at risk for adverse experiences. The protocol requires asking adults who present with intimate partner violence, suicidality, psychiatric disturbance, or severe substance abuse whether they care for children in any capacity. Those who are so identified are referred to a center at which support services are offered.³¹

Toxic stress impairs and sensitizes the stress response system, causes neuroinflammation and systemic inflammation, and leads to chronic illness, disability, and early death.

Uncertainty about the utility of existing tools. Many screening tools appear to be promising in terms of identification of the risk for, or actual, childhood adversity, patient and provider satisfaction, and their “fit” in the clinical workflow. Even so, no best practice guidelines exist in primary care to steer screening efforts. Questions remain about^27-29:

broad implementation of a specific tool
how, when, and where screening should take place
whether to screen adults, parents, or children—or all 3
how best to use the content and pacing of screening questions to promote self-regulation and prevent re-traumatization
best strategies for training and supporting health care workers around screening activities
how to optimally manage a positive screen.

How best to approach treatment

Treatment includes trauma-informed care, an organizational transformation process (described in TABLE 2³²; in “The lexicon of childhood adversity: Concepts and tools for care”^33-45; and in the subsection, “Lessons from neuroscience”), and individual treatment strategies. The Substance Abuse and Mental Health Services Administration (SAMHSA) of the US Department of Health and Human Services is advocating for implementation of trauma-informed approaches in health systems.

Continue to: The lexicon of childhood adversity...