Behavioral Medicine Toolkit Origins In 1985 Dr Vincent Felitti was the Chief of Preventative Medicine at Kaiser Permanente San Diego running a clinic for morbidly obese adults He accidentally discovered a surprising correlation between childhood sexual abuse and adult obesity eating ID: 780705
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Slide1
Adverse childhood experiences
Behavioral Medicine Toolkit
Slide2Origins
In 1985,
Dr
Vincent Felitti was the Chief of Preventative Medicine at Kaiser Permanente San Diego running a clinic for morbidly obese adultsHe accidentally discovered a surprising correlation between childhood sexual abuse and adult obesity – eating as a coping mechanismThis led him and Dr Robert Anda, a medical epidemiologist with the CDC, to explore the connection between childhood trauma and adult health
Dr
Vincent
Felitti
Dr Robert Anda
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Slide3Adverse childhood experiences
Selected from literature regarding childhood trauma and patient-reported experiences
In the original study 17,421 adults who were seen for initial evaluation at Kaiser responded to a survey self-reporting their childhood experiences
What they found has now been replicated in numerous studies around the worldSource: Robert Wood Johnson Foundation, 2013
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Slide4Prevalence of aces
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Slide5Effect of ACEs on adult health
An adult with 4 or more ACEs, in comparison to an adult with 0
ACEs,
is5
Slide6health behaviors
10.3
times more likely to use
injection drugs7.4 times more likely to be an alcoholic3.3 times more likely to engage in risky sexual behavior
3.23 times more likely to binge drink2.93 times more likely to be a current smoker
12.2 times more likely to attempt suicide
5.13 times more likely to suffer from depression4.22 times more likely to be diagnosed with
dementia
Mental health
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Slide7serious disease
2.42
times more likely to have
COPD2.4 times more likely to have a stroke2.2 times more likely to have ischemic heart disease
1.9 times more likely to have cancer1.86 times more likely to have asthma1.69 times more likely to have
kidney disease1.6 times more likely to have diabetes
11.6
times more likely to report being
forced to have sex after the age of 18
3.2
times more likely to report
having
50 or more sexual partners
A
woman with 3 violent ACEs is 3.3
times more likely to
become a victim of intimate partner violence
A man with 3 or more violent ACEs is 3.8
times more likely to
perpetrate intimate partner
violence
Sexual health
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Slide8The Ace pyramid
If
risk factors for disease, disability, and early mortality are not randomly distributed, what influences precede the adoption or development of them?
ACEs occur across the socioeconomic spectrum and correlate to, in a dose-dependent manner, poor health outcomes in adulthood.
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Slide9Well it’s too late now, right?
The case for primary prevention
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Slide10Aces can cause toxic
stress
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Slide1111
Maternal stress during pregnancy affects the developing fetal stress systems
Developmental effects
Critical periods of brain development are influenced by stress
Severe, chronic stress can result in a lower threshold for stress response
Slide12Early intervention
ACEs
Toxic Stress
Resilience
Secure attachment to a sensitive and responsive caregiver
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Slide13Addressing aces & trauma
w
ith families in the primary care setting
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Slide1414
When to intervene
Prenatal care
Infant well child visit
D
evelopmental or behavioral issues
Routine or targeted parental screening
Subsequent well child visit
Routine or targeted child screening
Slide15Barriers to identifying aces
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PROVIDER
discomfort
fear
stigma
judgment
consequences
PARENT
inappropriate
time
i
nadequate interventions
e
ffect on relationship
p
ersonal trauma
shame
Slide16Overcoming these barriers
16
Emphasize child wellbeing
Slide1717
Slide18The CYW model
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Slide19Strategic interviewing
A lot of pertinent information can be obtained from the content of our current well child check-ups
Who lives at home with the child?
Has your home life changed significantlyDevelopmental or behavioral concernsSchool performance, friendsCommunity and family resilience resourcesHas anything bad, sad, or scary happened to your child recently?How do you deal with stress?More direct questions may be required to identify domestic violence, substance abuse, bullying, or child abuse
How is the child coping with the traumatic event?19
Slide20Treatment – educational resources
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Trauma-informed anticipatory guidance
Slide21http://www.kidspot.com.au/10-phrases-you-hear-in-resilient-families-are-you-using-them/
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Slide2222
Slide23Treatment – county resources
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Home Visits
Hello Baby (West)
Welcome Home Baby (East/Central)
Public Health NurseChild Abuse Prevention Council
Mental health referral for therapy by age and region
Slide24But really, is it too late?
The case for secondary prevention
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Slide25References
Felitti
, Vincent J et al. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine, Volume 14, Issue 4, 245-258
http://www.cdc.gov/violenceprevention/acestudy/index.html, accessed 24 Oct 2015.“A Hidden Crisis: Findings on Adverse Childhood Experiences in California” Center for Youth WellnessNational Scientific Council on the Developing Child (2005/2014). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3. Updated Edition. Retrieved from www.developingchild.harvard.edu.Stevens, Jane Ellen. “The Adverse Childhood Experiences Study — the largest, most important public health study you never heard of — began in an obesity clinic.” 3 Oct 2012. Aces Too High. Web <acestoohigh.com> Accessed 25 Oct 2015
Randell KA, O’Malley D, Dowd M. Association of Parental Adverse Childhood Experiences and Current Child Adversity. JAMA Pediatr. 2015;169(8):786-787. doi:10.1001/jamapediatrics.2015.0269.Center for the Developing Child at Harvard University. Web < http://developingchild.harvard.edu/> Accessed 25 Oct 2015.“The ACE Study” CDC Injury Prevention & Control: Division of Violence Prevention. Web. < http://www.cdc.gov/violenceprevention/acestudy/index.html> Accessed 24 Oct 2015.Middlebrooks JS, Audage
NC. “The Effects of Childhood Stress on Health Across the Lifespan.” Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2008“Trauma Toolbox for Primary Care” American Academy of Pediatrics. 2014. Web < https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Trauma-Guide.aspx> Accessed 24 Oct 2015Stevens, Jane Ellen. “To prevent childhood trauma, pediatricians screen children and their parents…and sometimes, just parents…for childhood trauma” 29 July 2014. Aces Too High. Web. <acestoohigh.com> Accessed 25 Oct 2015
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