Adverse childhood experiences and biology of stress

Activities:

  1. WATCH: Nadine Burke Harris’s TED talk that introduces key concepts about Adverse Childhood Experiences and how they impact health.

GOAL: Define the scope and frequency of adverse childhood experiences (ACE) and toxic stress, the connection to illness across the lifespan, and opportunities for clinician intervention.

Dr. Nadine Burke Harris explains how incorporating an understanding of the frequency and effects of adverse childhood experiences (ACES) can impact medical practice.

Reflect: How can a physician’s understanding of ACEs impact their clinical practice and outcomes?

 

2. READ: Original ACEs study: Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine. 1998;14(4):245–258. doi:10.1016/s0749-3797(98)00017-8. 

GOAL: Define and provide examples of Adverse Childhood Experiences.  Review the relationship between various forms of trauma/violence/ACEs and health status or health care outcomes throughout the life course.

This massive prospective study is the original research that described the prevalence of certain “adverse childhood events” in a managed care population and provided evidence for the strong correlation with morbidity and mortality later in life. Please note: A caveat that some language in this original paper (“family dysfunction”) would not be used in the trauma informed care environment that this work ultimately produced.

REFLECT: How does this information change the way you think about chronic diseases such as diabetes?  In what way does the study population (white, employed, insured, middle class) affect your reading of this article?

OPTIONAL PRE-CLASS READING

1. READ (OPTIONAL): NYT article on WA state resilient community success story

GOAL: Apply concepts of resilience to responding to and preventing ACEs.

WA state was a leader in community level interventions to reduce ACEs and mitigate their outcomes.  Ready about some of these projects and outcomes.

REFLECT: How might physicians be involved in such projects?

2. READ (OPTIONAL): The Lifelong Effects of Early Childhood Adversity and Toxic Stress, Shonkoff et al, Pediatrics Jan 2012, 129 (1) , focusing on pages e235-238, and figure 2 on page e23

GOAL: Describe the proposed pathophysiologic mechanisms of toxic stress’ effect on health across the lifespan and the mediating effect of known resilience factors.

In this Pediatrics article, Shonkoff et al, delve into the science of toxic stress on the developing brain and the moderating effect of resilience factors.  Based on this science, they propose an “ecobiodevelopmental framework” from which the clinicians of the future should approach primary care.

REFLECT: What potential roles can clinicians take in responding to and preventing toxic stress?

3. READ (OPTIONAL): American Family Physician Curbside Consultation: Providing Trauma-Informed Care, Ravi A, Little, V.  May 2017https://www.aafp.org/afp/2017/0515/p655.html

GOAL: With deepened understanding of the prevalence and effects of childhood trauma, describe universal concrete actions that can be taken during the interview and exam to maximize emotional safety for patients.

This article was also provided in Immersion; it is provided here for clinical correlation.  Ravi and Little discuss trauma-informed care as a “…universal precaution to optimally address patient’s health care needs while decreasing the risk of traumatization.”

REFLECT: Have you seen these precautions taken in your clinical settings?

Additional Resources: