“We really want to be about prevention,” Dr. Gillespie said. “If we can be a little more upstream and prevent that cycle from repeating itself that will be the ultimate success.”
Parents are also asked to complete a separate questionnaire to measure their resilience – their ability to bounce back from difficult situations – so doctors can identify potential strengths to build on. The clinic, which serves a mostly insured population of diverse ethnic backgrounds, has screened more than 2,000 parents so far. About 40% indicated one traumatic childhood experience; 8% had four or more.
The most common was separation or divorce, followed by substance abuse and mental health issues in the family. The doctors offer tips on parenting or discipline to families who seem most in need. They also try to connect them with parenting classes or support groups.
At the beginning, Dr. Gillespie said it was difficult to bring up such personal questions, and he knows that not all parents are completely honest about their upbringing. But, he said, over time the screening has led to important conversations that wouldn’t have happened before, including about domestic violence. “I couldn’t go back to where we were before,” he said.
Several doctors in his office expressed skepticism at first, saying screening would take too much time and would open a can of worms. But they later said knowing more about their patients was helpful, and now 27 of the 28 providers use the screening, Dr. Gillespie said.
Others in Portland say poor families may not have the means to follow up on referrals to counseling or social services. And some argue that asking invasive questions can re-traumatize families. They say pediatricians should instead focus on educating all families in their practices.
But Ms. McVey, who brought in her daughter for a check-up with Dr. Gillespie, said she was glad to learn more about how her past could affect her children. “You may not realize that just because someone in your family had a drug problem that your kids may suffer from that,” she said. Ms. McVey remembers her father, who died earlier this year, having violent outbursts. Once, when she was 12, he left her alone in a hotel room to go get high. “As a kid, it’s tough watching your parent spiral out of control,” she said.
Ms. McVey said she doesn’t touch alcohol or drugs and tries to be patient with her daughters. But sometimes Madison can be really hyper – jumping off furniture and accidentally breaking dishes. “I yell at her, she starts crying and I start crying,” she said.
Dr. Gillespie suggested to her that Madison may also be trying to get her attention. As you play together, he said, praise her consistently. But as soon as Madison starts jumping on the couch, Gillespie said, you should immediately become silent. “She is probably going to stop because she is going to want to go back to the talking mom,” he said.
“It’s so nice to get advice on how to handle this,” Ms. McVey said afterward.
Another parent, 33-year-old Sarah Pike, who filled out the survey during a recent visit, marked “yes” to the questions about being emotionally and physically abused as a child.
“I was really afraid to become a parent,” Ms. Pike, 33, told Dr. Gillespie, as her infant daughter Payton rolled over on the exam table. “I was afraid that I was going to be a really mean person.”
“What do you think kept that from happening?” Gillespie asked.
“Remembering the torture I went through as a child and not wanting my children to be treated like I was,” Ms. Pike responded.
Dr. Gillespie told her that understanding what she went through in her own childhood is helpful – and will continue to be as she has ups and downs with Payton and her siblings.
Asking these questions can assure patients that his office is a safe place to raise sensitive problems that might otherwise go unaddressed, Dr. Gillespie explained.
“My families are getting the message that they can talk to me about whatever they need to,” he said.
Kaiser Health News is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.